The following is a summary of “Clinical effects of physiologic lesion testing in influencing treatment strategy for multi-vessel coronary artery disease,” published in the April 2024 issue of Cardiology by Rawal et al.

Researchers conducted a retrospective study to evaluate the utilization of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in guiding treatment decisions for multi-vessel coronary artery disease (CAD) based on angiographic and FFR/iFR results.

They used angiographic data to determine 270 patients with multi-vessel disease who underwent FFR/iFR testing. Patients were classified based on their angiographic findings and then re-evaluated from FFR/iFR results into normal or abnormal, categorizing lesions into target or non-target lesions based on clinical and non-invasive assessments.

The results demonstrated abnormal FFR/iFR values in 51.9% of patients, out of which 51.4% received coronary stenting (PCI) and 44.3% had bypass surgery (CABG). Medical therapy was preferred with two-vessel CAD when the target lesion was normal (72.6%), while PCI was preferred when it was abnormal (78.4%). PCI was preferred in non-target lesions regardless of FFR/iFR results (78.0%). For patients with three-vessel CAD, CABD was preferred \when the target lesion was abnormal (68.5%), with no difference in selected modality when it was normal. 

Additionally, LAD had higher lesion incidence than other arteries, and patients with two-vessel CAD and LAD stenosis were more often treated with PCI.

Investigators concluded that invasive physiological testing in patients with multi-vessel CAD could change the favored treatment approach, potentially resulting in a higher preference for PCI.

Source: sciencedirect.com/science/article/pii/S2666602224000211