Fractional Flow Reserve to Assess Coronary Artery Disease in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation: Long-Term Outcomes

Juva Benseba; Julien Mercier; Thomas Couture; Laurent Faroux; Laurence Bernatchez; Mélanie Côté; Vassili Panagides; Jules Mesnier; Siamak Mohammadi; Éric Dumont; Dimitri Kalavrouziotis; Sandra Hadjadj; Jonathan Beaudoin; Robert DeLarochellière; Josep Rodés-Cabau; Jean-Michel Paradis

doi:10.1016/j.shj.2023.100179

Fractional Flow Reserve to Assess Coronary Artery Disease in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation: Long-Term Outcomes

Struct Heart. 2023 Apr 18;7(4):100179. doi: 10.1016/j.shj.2023.100179. eCollection 2023 Jul.

Authors

Juva Benseba¹, Julien Mercier¹, Thomas Couture¹, Laurent Faroux¹, Laurence Bernatchez¹, Mélanie Côté¹, Vassili Panagides¹, Jules Mesnier¹, Siamak Mohammadi², Éric Dumont², Dimitri Kalavrouziotis², Sandra Hadjadj¹, Jonathan Beaudoin¹, Robert DeLarochellière¹, Josep Rodés-Cabau¹, Jean-Michel Paradis¹

Affiliations

¹ Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada.
² Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Canada.

Abstract

Background: The long-term outcomes of patients undergoing functional assessment of coronary lesions with fractional flow reserve (FFR) while awaiting transcatheter aortic valve implantation (TAVI) are unknown. Data on the safety of intracoronary adenosine use in this setting are scarce. The objectives of this study were to describe (1) the long-term outcomes based on the coronary artery disease (CAD) assessment strategy used and (2) the safety of intracoronary adenosine in patients with severe aortic stenosis (AS).

Methods: 1023 patients with severe AS awaiting TAVI were included. Patients were classified according to their CAD assessment strategy: angiography guided or FFR guided. Patients were further subdivided according to the decision to proceed with percutaneous coronary intervention (PCI): angiography-guided PCI (375/1023), angiography-guided no-PCI (549/1023), FFR-guided PCI (50/1023), and FFR-guided no-PCI (49/1023). Patients were followed up for the occurrence of major adverse cardiac and cerebrovascular events (MACCEs).

Results: At a mean follow-up of 33.7 months, we observed no significant differences in terms of major adverse cardiovascular and cerebrovascular events (MACCE) in the angiography-guided group (42.4%) compared with the FFR-guided group (37.4%) (p = 0.333). When comparing outcomes of the FFR-guided no-PCI group (32.7%) with the angiography-guided PCI group (46.4%), no significant difference was noted (p = 0.999). Following intracoronary adenosine, a single adverse event occurred.

Conclusions: In this population, intracoronary adenosine is safe and well tolerated. We found no significant benefit to an FFR-guided strategy compared with an angiography-guided strategy with respect to MACCEs. Although clinically compelling, avoiding the procedural risks of PCI by deferring the intervention in functionally insignificant lesions failed to show a statistically significant benefit.

Keywords: Aortic valve stenosis; Coronary artery disease; Fractional flow reserve; Intracoronary adenosine; Transcatheter aortic valve implantation.