Clinical outcomes of FFR-guided revascularisation of non-culprit lesions in NSTE-ACS

BACKGROUND: The role of fractional flow reserve (FFR)-guided revascularisation in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is unclear. AIMS: We sought to compare the outcomes of FFR-guided and angiography-guided revascularisation in patients with NSTE-ACS and chronic coronary syndrome (CCS). METHODS: Individual patient data from five randomised clinical trials comparing FFR- and angiography-guided percutaneous coronary intervention (PCI) were pooled and stratified according to the coronary syndrome subtype. The primary outcome was major adverse cardiovascular events (MACE) at 1 year. RESULTS: Overall, 2,493 patients were considered, including 1,316 (52.8%) with CCS and 1,177 (47.2%) with NSTE-ACS. The relationship between an FFR-guided strategy and the risk of MACE at 1 year was similar across the two groups (CCS: hazard ratio [HR] 0.78, 95% confidence interval [CI]: 0.58-1.05; NSTE-ACS: HR 0.86, 95% CI: 0.63-1.18; p-value for interaction [p-int]=0.792). Similar findings were found for all-cause death (p-int=0.459), myocardial infarction (p-int=0.996) and repeat revascularisation (p-int=0.290). These results were confirmed through an extended exploratory analysis at 5 years of follow-up. In patients with NSTE-ACS randomised to FFR-guided revascularisation, the number of deferred lesions was not associated with an increased risk of MACE. CONCLUSIONS: FFR-guided revascularisation is associated with a similar clinical benefit in NSTE-ACS and CCS settings. An FFR-guided strategy should be considered to safely reduce unnecessary PCI in patients with NSTE-ACS.