Fractional Flow Reserve to Guide Revascularization in Patients With Coronary Artery Disease Undergoing TAVR
: Jørgensen, Troels Højsgaard; Engstrøm, Thomas; Jabbari, Reza; Glinge, Charlotte; Sabbah, Muhammed; Veien, Karsten Tange; Niemela, Matti; Freeman, Phillip; Linder, Rickard; Sørensen, Rikke; Holmvang, Lene; Ioanes, Dan; Terkelsen, Christian Juhl; Ellert-Gregersen, Julia; Christiansen, Evald; Eftekhari, Ashkan; Piuhola, Jarkko; Kajander, Olli; Koul, Sasha; Savontaus, Mikko; Karjalainen, Pasi; Søndergaard, Lars; De Backer, Ole; Lønborg, Jacob
Publisher: Elsevier BV
: 2025
JACC: Cardiovascular Interventions
: 18
: 23
: 2925
: 2936
: 1936-8798
: 1876-7605
DOI: https://doi.org/10.1016/j.jcin.2025.10.015
: https://doi.org/10.1016/j.jcin.2025.10.015
BackgroundThe prognostic value of fractional flow reserve (FFR) in assessing coronary stenosis before transcatheter aortic valve replacement (TAVR) is unclear.ObjectivesThe aim of this study was to evaluate cardiovascular risks associated with significant and nonsignificant FFR values of coronary stenosis prior to TAVR.MethodsPatients 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.ResultsOf 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).
ConclusionsConservative 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
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This research was funded by Boston Scientific and the Danish Heart Foundation. Dr Savontaus has received intuitional research grants and consulting fees from Medtronic. Dr Piuhola has received honoraria from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr De Backer has received consulting fees from Abbott Laboratories, Boston Scientific, and Medtronic. Dr Christiansen has received honoraria from Meril. Dr Engstrøm has received consulting fees from Novo Nordisk, Boston Scientific, and Abbott Cardiovascular; and is a data and safety monitoring board member for the INFINITY and Pure-TAVI trials. Dr Lønborg has received consulting fees from Boston Scientific and Abbott Cardiovascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
