JACC Cardiovasc Interv. 2025 Dec 8;18(23):2925-2936. doi: 10.1016/j.jcin.2025.10.015.
ABSTRACT
BACKGROUND: The prognostic value of fractional flow reserve (FFR) in assessing coronary stenosis before transcatheter aortic valve replacement (TAVR) is unclear.
OBJECTIVES: The aim of this study was to evaluate cardiovascular risks associated with significant and nonsignificant FFR values of coronary stenosis prior to TAVR.
METHODS: Patients were enrolled from the NOTION-3 (Nordic Aortic Valve Intervention-3) randomized trial and registry, including those with severe aortic stenosis scheduled for TAVR and ≥50% coronary stenosis. Patients with FFR ≤0.80 or stenosis ≥90% were randomized to conservative therapy (FFR ≤0.80 conservative group) or percutaneous coronary intervention (PCI; FFR ≤0.80 PCI group). Those with FFR >0.80 were included in the registry (FFR >0.80 defer group). Outcomes were cardiovascular death, myocardial infarction, and/or urgent revascularization through 36 months.
RESULTS: Of 587 patients, 232 were in the FFR ≤0.80 conservative group, 220 in the FFR ≤0.80 PCI group, and 135 in the FFR >0.80 defer group. The cumulative incidence rates of cardiovascular death, myocardial infarction, or urgent revascularization were 21.6%, 11.5%, and 10.5%, respectively (P = 0.003). Excess risk in the FFR ≤0.80 conservative group was due mainly to higher myocardial infarction and urgent revascularization rates compared with the other groups. At a coronary lesion level, revascularization occurred in 12.6% of conservatively treated FFR ≤0.80 segments vs 1.3% of PCI-treated FFR ≤0.80 segments and 0.9% of deferred FFR >0.80 segments (P < 0.0001).
CONCLUSIONS: Conservative management of FFR ≤0.80 lesions was linked to higher cardiovascular risk compared with either PCI of FFR ≤0.80 lesions or deferral of FFR >0.80 lesions, which had similar outcomes. These findings support an FFR threshold of 0.80 to guide coronary revascularization in patients undergoing TAVR. (Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation [NOTION-3]; NCT03058627).
PMID:41371788 | DOI:10.1016/j.jcin.2025.10.015