Clinical Decision-Making for the Hemodynamic "gray Zone" (FFR 0.75-0.80) and Long-Term Outcomes

Shiv Kumar Agarwal, Srikanth Kasula, Mohan M. Edupuganti, Sameer Raina, Fnu Shailesh, Ahmed Almomani, Jason J. Payne, Naga V. Pothineni, Barry F. Uretsky, Abdul Hakeem

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

BACKGROUND: Fractional flow reserve (FFR) value between 0.75 and 0.80 is considered the "gray zone" and outcomes data relative to treatment strategy (revascularization vs medical therapy alone [deferral]) are limited for this group. METHODS AND RESULTS: A total of 238 patients (64.3 ± 8.6 years; 97% male; 45% diabetic) with gray-zone FFR were followed for the primary endpoint of major adverse cardiovascular event (MACE), defined as a composite of death, myocardial infarction (MI), and target-vessel revascularization. Mean follow-up duration was 30 ± 17 months. Deferred patients (n ≤ 48 [20%]) had a higher prevalence of smoking and chronic kidney disease compared with the percutaneous coronary intervention (PCI) group (n ≤ 190 [80%]; P<.05). Patients who underwent PCI had significantly lower MACE compared with the deferred patients (16% vs 40%; log rank P<.01). While there was a trend toward a decrease in all-cause mortality (8% vs 19%; log rank P≤.06), the composite of death or MI was significantly lower in the PCI group (9% vs 27%; P<.01). On multivariate Cox proportional hazards regression analysis, PCI was associated with lower MACE (hazard ratio, 0.5; 95% confidence interval, 0.27-0.95; P≤.03). CONCLUSION: Revascularization for patients with gray-zone FFR was associated with a significantly reduced risk of MACE compared with medical therapy alone.

Original languageEnglish (US)
Pages (from-to)371-376
Number of pages6
JournalJournal of Invasive Cardiology
Volume29
Issue number11
StatePublished - Nov 2017
Externally publishedYes

Keywords

  • coronary artery disease
  • major adverse cardiovascular event
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Agarwal, S. K., Kasula, S., Edupuganti, M. M., Raina, S., Shailesh, F., Almomani, A., Payne, J. J., Pothineni, N. V., Uretsky, B. F., & Hakeem, A. (2017). Clinical Decision-Making for the Hemodynamic "gray Zone" (FFR 0.75-0.80) and Long-Term Outcomes. Journal of Invasive Cardiology, 29(11), 371-376.