Cardiovasc Revasc Med. 2026 Jan 23:S1553-8389(26)00013-8. doi: 10.1016/j.carrev.2026.01.012. Online ahead of print.
ABSTRACT
BACKGROUND: Wire-based fractional flow reserve (wbFFR) is the gold standard for physiologic assessment of coronary artery disease (CAD). Recently, angiogram-based FFRangio have shown good diagnostic performance against wbFFR. Limited outcome data is available for FFRangio. The present study aimed to investigate the clinical outcomes of FFRangio-guided treatment for CAD in real-world practice.
METHODS: In an international multicentre registry, CAD patients assessed using FFRangio underwent angiography/revascularisation at 7 centres. The primary endpoint was 1-year cumulative incidence of cardiovascular death/myocardial infarction (MI)/unplanned revascularisation (UR).
RESULTS: Our cohort included 2129 lesions from 1579 patients. In 1951 lesions (91.6%) and 1435 patients (90.9%), treatment was concordant with FFRangio results. Mean age was 70.3 years and 30.6% were female. Mean FFRangio was 0.86 (0.66 and 0.95 in the revascularised and deferred lesions, respectively). After a median follow up of 365 (Q1-Q3: 326-365) days, the primary endpoint for the revascularisation and deferral groups was 6.8% and 1.6% (cardiovascular death 0% and 0.4%, MI 1.0% and 0.1%, UR 6.8% and 1.2%). Risk for the primary endpoint was 3.6% and 8.7% in the concordant and discordant groups, respectively (adjusted HR 0.38 [95%CI: 0.19-0.88], p = 0.006), driven by lower incidence of event in the concordant revascularisation vs. discordant deferral groups (6.8 vs. 12.3%, HR 0.43 [95%CI: 0.19-0.95], p = 0.038).
CONCLUSIONS: In real-world setting, FFRangio-guided treatment yields excellent one-year outcomes for both revascularisation and deferred lesion, which are comparable with current data for wbFFR-guided treatment. FFRangio-concordant revascularisation was associated with better prognosis than FFRangio-discordant deferral for patients with FFRangio ≤ 0.8.
TRIAL REGISTRATION: NCT05648396.
PMID:41620337 | DOI:10.1016/j.carrev.2026.01.012