C 2010, Wiley Periodicals, Inc. DOI: 10.1111/j.1540-8183.2010.00579.x ACUTE CORONARY SYNDROME The Prognostic Value of Combined Fractional Flow Reserve and TIMI Frame Count Measurements in Patients with Stable Angina Pectoris and Acute Coronary Syndrome ALI M. ESEN, M.D., 1 GOKSEL ACAR, M.D., 1 OZLEM ESEN, M.D., 2 YUNUS EMIROGLU, M.D., 1 MUSTAFA AKCAKOYUN, M.D., 1 SELCUK PALA, M.D., 1 HEKIM KARAPINAR, M.D., 3 RAMAZAN KARGIN, M.D., 1 IRFAN BARUTCU, M.D., 4 and MUHSIN TURKMEN, M.D. 1 From the 1 Department of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Heart-Education and Research Hospital, Istanbul, Turkey; 2 Department of Cardiology, Memorial Hospital, Istanbul, Turkey; 3 Department of Cardiology, VanYuksek Ihtisas Hospital, Van,Turkey; and 4 Department of Cardiology, Avicenna Hospital, Istanbul, Turkey Background: The aim of this study was to evaluate the prognostic value of different fractional flow reserve (FFR) cutoff values and corrected thrombolysis in myocardial infarction frame (TIMI) count (CTFC) measurements in a series of consecutive patients with moderate coronary lesions, including patients with unstable angina, myocardial infarction, and/or positive noninvasive functional test findings. Methods: We included 162 consecutive coronary patients in whom revascularization of a moderate coronary lesion was deferred based on a FFR value ≥0.75. Patients were divided according to the results of the intracoronary pressure and flow measurements into four groups: group A: 0.75 ≤ FFR ≤ 0.85 and CTFC > 28 (n = 22), group B: 0.75 ≤ FFR ≤ 0.85 and CTFC ≤ 28 (n = 55), group C: 0.85 < FFR and CTFC > 28 (n = 19), and group D: 0.85 < FFR and CTFC ≤ 28 (n = 66). Adverse cardiac events and the presence of angina were evaluated at follow-up. Results: At a mean follow-up of 18 ± 10 months, cardiac event rate in patients with 0.75 ≤ FFR ≤ 0.85 and FFR > 0.85 were 22% and 9%, respectively (P = 0.026) and also, a trend was observed toward a higher cardiac event rate in case of an abnormal CTFC (CTFC > 28) compared to a normal CTFC (24% vs 12%, P = 0.066). Furthermore, a significantly higher cardiac event rate was observed when group A was compared to group D (31.8% vs 7.6%, respectively, P = 0.004). Conclusion: Patients with potential microvascular dysfunction and borderline FFR values should be interpreted with caution, and management strategies should be guided not only by pressure measurement, but also by possibly supplementary clinical risk stratification and noninvasive tests. (J Interven Cardiol 2010;23:421–428) Introduction Myocardial fractional flow reserve (FFR) is a well- established index of the physiological significance of a coronary artery stenosis. 1–3 It has been studied in pa- tients with single 4 and multivessel coronary disease, 5 as well as after stent implantation. 6 It has been implied Address for reprints: Ozlem Esen, M.D., Barbaros Mh. Ihlamur Sk., Uphill-Court sitesi A2 blok D:51 Atasehir, Istanbul, Turkey. Fax: +90 212 314 6613; e-mail: ozlembat@hotmail.com by these studies that measurement of FFR is a useful tool for predicting the outcome both in patients treated conservatively and in those undergoing coronary inter- vention. Numerous studies have proved the safety of deferring coronary revascularization in patients with moderate coronary lesions on the basis of FFR mea- surements of ≥0.75. 4,5,7,8 However, in all these studies the mean FFR value was >0.85, suggesting that most of the patients had an FFR value >0.80. Furthermore, in studies involving patients after balloon angioplasty 9 and/or stent implantation, 6 an inverse correlation was Vol. 23, No. 5, 2010 Journal of Interventional Cardiology 421