Real-World Outcomes of FFRangio-Guided Treatment for Coronary Artery Disease in Acute Versus Chronic Coronary Syndromes.

BACKGROUND

The use of angiogram-based fractional flow reserve technologies in routine clinical practice is increasing steadily. Available data suggest that it is associated with comparable clinical outcomes compared with wire-based fractional flow reserve (FFR), but evidence is still limited, especially in patients with acute coronary syndromes (ACSs). The aim of this study was to examine the real-world clinical outcomes of an angiogram based fractional flow reserve technology (FFRangio; CathWorks, Kfar-Saba, Israel) to guide treatment for coronary artery disease in patients presenting with acute versus chronic coronary syndromes (CCSs).

METHODS

This is a retrospective, observational study. Our cohort included consecutive patients undergoing coronary angiography in 7 centers (Japan, 6; Israel, 1), whose treatment was guided by FFRangio between January 2021 and December 2023. The primary end point was 2-year cumulative incidence of major adverse cardiac events, stratified by presentation (ACS/CCS) and treatment strategy (revascularization/deferral).

RESULTS

Overall, 2245 patients (ACS, 756; CCS, 1489) were included. Patients with ACS were younger and more likely to be diabetic. At 2 years, ACS presentation resulted in higher risk of major adverse cardiac events (9.8% versus 5.6%; HR, 1.80; P<0.001). Stratified by presentation and treatment, deferred patients had similar risk of major adverse cardiac events (ACS, 5.4%; CCS, 4.7%; HR, 1.08; P=0.672) for treated patients, ACS presentation associated with increased risk for major adverse cardiac events (11.7% versus 7.3%; HR, 1.64; P<0.001).

CONCLUSIONS

In a real-world setting, FFRangio-guided treatment yields 2-year outcomes comparable with current data for wire-based fractional flow reserve for both patients with ACS and patients with CCS. ACS presentation is associated with increased risk for major adverse cardiac events in patients undergoing FFRangio-guided revascularization but not deferral. These results demonstrate the clinical utility of FFRangio-guided treatment across the spectrum of coronary artery disease presentation excluding ST-segment-elevation myocardial infarction.

REGISTRATION: URL: https://clinicaltrials.gov/study/NCT05648396?term=FFRangio%20&viewType=Card&rank=3; Unique Identifier: NCT05648396.