Skip to content
DraconiticResearch
Search Sources API
190,839 studies31 sourcesUpdated 6 min ago
Peer-reviewedCC BY-NC-ND 4.0Catheterization and Cardiovascular Interventions

Clinical Impact of Adherence to Fractional Flow Reserve Guidance in Acute Coronary Syndrome

  • Eun Ho Choo1
  • Ik Jun Choi2
  • Sungmin Lim3
  • Donggyu Moon4
  • Dae‐Won Kim5
  • Kiyuk Chang1
5 affiliations
  1. 1Department of Internal Medicine Division of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
  2. 2Department of Internal Medicine Division of Cardiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Incheon Republic of Korea
  3. 3Department of Internal Medicine Division of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Uijeongbu Republic of Korea
  4. 4Department of Internal Medicine Division of Cardiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon Republic of Korea
  5. 5Department of Internal Medicine Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Daejeon Republic of Korea
Read full textPDFDOICite

Abstract

Background: Fractional flow reserve (FFR) is established to guide revascularization in stable coronary disease and non‐culprit lesions in acute coronary syndromes (ACS). However, real‐world adherence to FFR guidance across the spectrum of ACS presentations, including ambiguous culprit scenarios, remains incompletely characterized.

Aims: To evaluate the clinical impact of adherence to FFR guidance in ACS.

Methods: From a multicenter prospective FFR registry, we analyzed 501 ACS patients who underwent FFR measurement: 222 with clear culprit lesions and 279 with ambiguous culprit lesions. Patients were classified as FFR‐concordant (all FFR ≤ 0.80 treated; all FFR > 0.80 deferred) or FFR‐discordant (≥ 1 FFR‐hemodynamic mismatch). The patient‐oriented composite endpoint (POCE) comprised all‐cause death, myocardial infarction, or any revascularization; the patient‐oriented FFR‐related composite endpoint (POFRC) comprised cardiac death or myocardial infarction or revascularization involving an FFR‐assessed vessel at 2 years.

Results: Among 501 patients, 431 (86%) received FFR‐concordant management and 70 (14%) FFR‐discordant management. FFR discordance clustered in the gray zone (0.75–0.85), with 3.5‐fold higher prevalence compared with other FFR ranges. Over 2 years, FFR‐discordant management was associated with significantly higher POCE (Kaplan−Meier incidence 20.0% vs. 10.4%; propensity‐weighted hazard ratio [HR] 2.33, 95% confidence interval [CI] 1.27–4.29, p = 0.009). The POFRC confirmed and strengthened this association (19.0% vs. 8.8%; propensity‐weighted HR 2.59, 95% CI 1.37–4.91, p = 0.004). The adverse impact of FFR discordance was consistent across clear culprit and ambiguous culprit subgroups (p for interaction = 0.52) and across types of ACS (p for interaction = 0.91).

Conclusions: In real‐world ACS management, adherence to FFR guidance is associated with superior clinical outcomes compared with FFR‐discordant decision‐making.

Related

  1. Adherence-related factors associated with weight reduction: clinical outcomes of telerehabilitation in patients with metabolic syndrome
    Judit Erzsébet Ábrahám, Anna Vágvölgyi, Éva Máthéné Köteles +10
    Frontiers in Cardiovascular MedicinePeer-reviewedCC BY 4.0Full textCardiovascular medicineCrossrefDOAJ
  2. Combined Triglyceride–High-density Lipoprotein Cholesterol Phenotypes and Cardiovascular Outcomes in Japanese Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Insights from Clinical Deep Data Accumulation System-PCI
    Mitsukuni Kimura, Shunsuke Katsuki, Yasuhiro Nakano +26
    Journal of Atherosclerosis and ThrombosisPeer-reviewedCC BY-NC-SAFull textSurgery & anaesthesiaJ-STAGE
  3. The clinical chameleon: eosinophilic myocarditis presenting as acute coronary syndrome-a case report.
    Denise Belén Magnifico, Ignacio Melem, Sergio Baratta +1
    European heart journal. Case reportsPeer-reviewedCC BYFull textCardiovascular medicineEurope PMCPMC
  4. Deep dynamic coronary roadmap guidance in percutaneous coronary intervention: a deep learning approach
    Chih-Kuo Lee, Yen-An Lin, Chia-Ling Wu +3
    Scientific ReportsPeer-reviewedCC BY-NC-ND 4.0Full textSurgery & anaesthesiaCrossref
  5. Clinical Utility of Serum Neuropeptide Q in Patients With Acute Coronary Syndrome: A Case-Control Observational Pilot Study.
    A Shaik Mohamed Shameer, Prashant S Adole, Kolar V Vinod
    CureusPeer-reviewedCC BYFull textCardiovascular medicineEurope PMCPMC

Cite

BibTeXRIS
BibTeX
@article{choo2026clinical,
  title = {{Clinical Impact of Adherence to Fractional Flow Reserve Guidance in Acute Coronary Syndrome}},
  author = {Eun Ho Choo and Ik Jun Choi and Sungmin Lim and Donggyu Moon and Dae‐Won Kim and Kiyuk Chang},
  journal = {Catheterization and Cardiovascular Interventions},
  year = {2026},
  month = sep,
  doi = {10.1002/ccd.70853},
  url = {https://doi.org/10.1002/ccd.70853},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Clinical Impact of Adherence to Fractional Flow Reserve Guidance in Acute Coronary Syndrome
AU  - Eun Ho Choo
AU  - Ik Jun Choi
AU  - Sungmin Lim
AU  - Donggyu Moon
AU  - Dae‐Won Kim
AU  - Kiyuk Chang
PY  - 2026
DA  - 2026/09/11
JO  - Catheterization and Cardiovascular Interventions
DO  - 10.1002/ccd.70853
UR  - https://doi.org/10.1002/ccd.70853
AB  - Background: Fractional flow reserve (FFR) is established to guide revascularization in stable coronary disease and non‐culprit lesions in acute coronary syndromes (ACS). However, real‐world adherence to FFR guidance across the spectrum of ACS presentations, including ambiguous culprit scenarios, remains incompletely characterized.  Aims: To evaluate the clinical impact of adherence to FFR guidance in ACS.  Methods: From a multicenter prospective FFR registry, we analyzed 501 ACS patients who underwent FFR measurement: 222 with clear culprit lesions and 279 with ambiguous culprit lesions. Patients were classified as FFR‐concordant (all FFR ≤ 0.80 treated; all FFR > 0.80 deferred) or FFR‐discordant (≥ 1 FFR‐hemodynamic mismatch). The patient‐oriented composite endpoint (POCE) comprised all‐cause death, myocardial infarction, or any revascularization; the patient‐oriented FFR‐related composite endpoint (POFRC) comprised cardiac death or myocardial infarction or revascularization involving an FFR‐assessed vessel at 2 years.  Results: Among 501 patients, 431 (86%) received FFR‐concordant management and 70 (14%) FFR‐discordant management. FFR discordance clustered in the gray zone (0.75–0.85), with 3.5‐fold higher prevalence compared with other FFR ranges. Over 2 years, FFR‐discordant management was associated with significantly higher POCE (Kaplan−Meier incidence 20.0% vs. 10.4%; propensity‐weighted hazard ratio [HR] 2.33, 95% confidence interval [CI] 1.27–4.29, p = 0.009). The POFRC confirmed and strengthened this association (19.0% vs. 8.8%; propensity‐weighted HR 2.59, 95% CI 1.37–4.91, p = 0.004). The adverse impact of FFR discordance was consistent across clear culprit and ambiguous culprit subgroups (p for interaction = 0.52) and across types of ACS (p for interaction = 0.91).  Conclusions: In real‐world ACS management, adherence to FFR guidance is associated with superior clinical outcomes compared with FFR‐discordant decision‐making.
SN  - 1522-1946
SN  - 1522-726X
ER  -