Clinical Outcomes of Deferred Revascularisation Using Fractional Flow Reserve in Diabetic Patients

• Published in: Cardiovascular revascularization medicine 2020-07, Vol.21 (7), p.897-902
• Main Authors: Alkhalil, Mohammad, McCune, Claire, McClenaghan, Lisa, Mailey, Jonathan, Collins, Patrick, Kearney, Aileen, Todd, Matthew, McKavanagh, Peter
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Catheterization; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary Stenosis - diagnosis; Coronary Stenosis - mortality; Coronary Stenosis - physiopathology; Coronary Stenosis - therapy; Deferred revascularisation; Diabetes; Diabetes Mellitus - diagnosis; Diabetes Mellitus - mortality; Female; FFR; Fractional Flow Reserve, Myocardial; Humans; Male; Middle Aged; Myocardial Revascularization - adverse effects; Myocardial Revascularization - mortality; Northern Ireland; Predictive Value of Tests; Risk Assessment; Risk Factors; Time Factors; Time-to-Treatment; Treatment Outcome
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2019.12.019

Fractional flow reserve (FFR) is used to assess the functional significance of coronary artery lesions. Diabetic patients are associated with high burden of atherosclerosis and microvascular dysfunction. We studied the clinical outcomes of diabetic patients who underwent FFR-guided deferred revascularisation. Consecutive patients from a single large volume centre who underwent FFR assessment were included. Clinical endpoints were prospectively collected using the national electronic care records system. The primary endpoint was defined as the four-year risk of the vessel-oriented composite outcome of cardiac death, vessel-related myocardial infarction (VMI), and vessel-related urgent revascularisation (VUR). Absolute FFR values groups (0.81 to 0.85; 0.86 to 0.90; and >0.90) were used to further stratify patient outcomes. FFR-guided deferred revascularisation occurred in 860 patients (63%), of whom 159 were diabetic. The primary endpoint was significantly higher in the diabetic compared to the non-diabetic group [HR 1.76 (95%CI 1.08 to 2.88), P = 0.024]. The difference was driven from cardiac death (6.3% vs. 3.0%, P = 0.044) and VMI (5.0% vs. 1.7%, P = 0.012) but not VUR (8.8% vs. 5.1%, P = 0.07). There was a significant decrease in the incidence of the primary endpoint in the diabetic group according to FFR groups (23.6%, 12.3%, 2.4%, P = 0.001) with comparable clinical outcomes in the non-diabetic group (11.8%, 6.4%, 7.4%, P = 0.085). Our study demonstrated an increased risk of death and target vessel MI in diabetic patients undergoing FFR-guided deferred revascularisation compared to non-diabetic group. Nonetheless, FFR remained a useful tool to identify those at future risk, mainly in diabetic patients. •In FFR-guided deferred coronary lesions, diabetic patients were at increased future risk when compared to non-diabetic.•This risk was mainly driven from cardiac death and target vessel MI but not target vessel revascularisation.•The future risk was proportional to the degree of ischaemia by FFR in the diabetic but not in the non-diabetic group.