Outcome of coronary lesions with deferred revascularization due to negative fractional flow reserve in subjects with acute coronary syndrome Andrea Picchi a, ⁎ ,1 , Antonio Maria Leone b,1 , Filippo Zilio c,1 , Enrico Cerrato d,1 , Fabrizio D'Ascenzo e,1 , Massimo Fineschi f,1 , Stefano Rigattieri g,1 , Marco Ferlini h,1 , Matteo Cameli f,1 , Paolo Calabria a,1 , Alberto Cresti a,1 , Ugo Limbruno a,1 a Division of Cardiology, Misericordia Hospital, Grosseto, Italy b Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy c Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy d Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy e Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy f Department of Cardiology, University Medical Hospital of Siena, Siena, Italy g Division of Cardiology, Sandro Pertini Hospital, Rome, Italy h Fondazione IRCCS Policlinico San Matteo, Pavia, Italy abstract article info Article history: Received 15 August 2016 Received in revised form 21 November 2016 Accepted 17 December 2016 Available online xxxx Objective: Revascularization of functionally non-significant stenoses in patients with stable coronary artery disease can safely be deferred as rate of adverse cardiovascular events is low. It is not clear whether fractional flow reserve (FFR) is just as accurate in acute coronary syndromes (ACS). The aim of this study is to assess the outcome of coronary lesions whose revascularization was deferred based on negative FFR values in subjects with ACS. Methods: Patients with acute coronary syndrome and showing at least one coronary stenosis whose revascular- ization was deferred based on FFR value N 0.80 were included in the study. The primary endpoint of the study was the rate of target lesion failure (TLF), a composite of cardiac events (cardiac death, myocardial infarction and any coronary revascularization) related to the initially deferred stenosis at three-year follow-up. Results: A total of 319 patients (237 male), mean age 68 [59–74] years and 355 coronary lesions with deferred revascularization based on negative FFR values (0.88 ± 0.05) were selected. The rate of TLF was 6% at 1-year, 9% at 2-year and 12% at 3-year follow-up. TLF was driven by a new acute coronary syndrome in 75% of cases. The median time interval from FFR assessment to TLF was 457 [138–868] days. Conclusions: In patients with acute coronary syndrome, the rate of TLF of the initially deferred coronary stenoses is 12% at 3-year follow-up and TLF occurred because of a new ACS in three quarters of cases. © 2016 Elsevier Ireland Ltd. All rights reserved. Keywords: Fractional flow reserve Acute coronary syndrome Coronary revascularization 1. Introduction Fractional flow reserve (FFR) is a well-validated technique to guide coronary intervention by identification of lesion-level ischemia [1]. Revascularization of physiological significant stenoses is associated with improved cardiovascular outcomes and symptoms [2,3]. Converse- ly, non-significant stenoses are not associated with inducible ischemia and previous studies suggest their revascularization can safely be deferred as rates of cardiovascular death and myocardial infarction (MI) are low [2–8]. These data mainly refer to patients with stable coronary artery disease, whereas the diagnostic validity of FFR is less certain in subjects affected by acute coronary syndrome (ACS) due to some physiological concerns: first, FFR accuracy is critically dependent on the ability to achieve maximal hyperemia but microvascular vasodi- latation may be impaired in ACS [9,10]. Second, ACS patients are likely to present variable degrees of left ventricle dysfunction and FFR measure- ment might be affected by left ventricle end diastolic pressure [11]. Third, FFR has the ability to identify vessels with physiologically restrict- ed coronary flow, but cannot detect atherosclerotic plaques with International Journal of Cardiology xxx (2016) xxx–xxx ⁎ Corresponding author at: Cardiology Unit, Misericordia Hospital, Grosseto, Italy. E-mail address: andre.picchi@gmail.com (A. Picchi). 1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. IJCA-24287; No of Pages 4 http://dx.doi.org/10.1016/j.ijcard.2016.12.109 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard Please cite this article as: A. Picchi, et al., Outcome of coronary lesions with deferred revascularization due to negative fractional flow reserve in subjects with acute coronar..., Int J Cardiol (2016), http://dx.doi.org/10.1016/j.ijcard.2016.12.109