ABSTRACT

Fractional flow reserve (FFR), a measure of coronary blood flow during cardiac catheterization, has emerged as a crucial tool for guiding revascularization decisions in patients with coronary artery disease (CAD). However, its impact on long-term survival, particularly in individuals with coexisting peripheral arterial disease (PAD), remains unclear. This study investigated the association between FFR and 5-year survival in patients with cardiac arterial disorders (CAD or PAD). We conducted a retrospective cohort study. Patients diagnosed with CAD or PAD between 2021 and 2023 who underwent cardiac catheterization with FFR measurement were eligible. Exclusion criteria included prior revascularization for the relevant artery, presence of significant left main stem stenosis, and incomplete medical records. We identified 104 patients meeting the inclusion criteria and collected data on baseline demographics, comorbidities, medical history, and FFR values. The primary outcome was all-cause mortality within 5 years of FFR measurement. Secondary outcomes included incident major adverse cardiovascular events (MACE) and myocardial infarction (MI). Patients were categorized based on FFR values: normal (>0.8), mildly impaired (0.7-0.8), and severely impaired (<0.7). Kaplan-Meier analysis estimated 5-year survival rates across FFR categories. Cox proportional hazards regression assessed the independent association between FFR and the primary outcome, adjusting for potential confounders like age, sex, comorbidities, and presence of PAD. Similar analyses were conducted for secondary outcomes. Patients with lower FFR exhibited significantly decreased 5-year survival rates compared to those with normal FFR (65% vs. 82%, p<0.001). In adjusted Cox regression, severely impaired FFR was associated with a 2.6-fold increased risk of mortality (Hazard Ratio [HR] 2.6, 95% Confidence Interval [CI] 1.7-4.0, p<0.001). This association remained significant even after further adjustment for incident MACE and MI. Additionally, lower FFR was associated with increased risk of MACE (HR 1.8, 95% CI 1.3-2.5, p=0.002) and MI (HR 1.5, 95% CI 1.1-2.1, p=0.02). This study demonstrates a strong association between lower FFR and decreased 5-year survival in patients with cardiac arterial disorders, independent of major cardiovascular events. These findings suggest that FFR may provide valuable prognostic information beyond its established role in guiding revascularization decisions. Incorporating FFR into comprehensive risk assessment could personalize clinical management and optimize long-term outcomes for patients with these prevalent conditions.

Keywords

Fractional flow reserve, cardiac arterial disorder, coronary artery disease, peripheral arterial disease, survival, prognosis, revascularization.

MJE-013