CaFFR Guided Revascularization Show Reduced MACE Risk in Diabetic Patients with CAD

The emerge of computational pressure-flow dynamics derived flow reserve (caFFR) for non-invasive assessment of fractional flow reserve (FFR) in patients with stable coronary artery disease (CAD) has provided a new avenue in treatment, particularly without the need for hyperemic induction and guidewire placement in conventional FFR.

However, the clinical value of caFFR in diabetic patients at risk of microvascular dysfunction has not been validated. Accordingly, a recent study presented at the American Heart Association 2021 Meeting aimed to evaluate the use of caFFR in diabetic patients with stable CAD.

Led by Kwan Yu LI, The University of Hong Kong, Li Ka Shing Faculty of Medicine, a team of investigators observed in these patients, caFFR-guided revascularization had a significant reduction in the risk of MACE in 3 years.

The study included a total of 212 stable CAD patients with diabetes, who had a mean age of 67.6±10.6 years and were 66.5% male.

Patients were considered adherent to caFFR if all ischemic vessels, defined by caFFR ≤0.8, were treated with percutaneous coronary intervention (PCI). On the other hand, all nonischemic vessels, defined by caFFR >0.8 were not treated with PCI.

Li and colleagues noted that any otherwise, patients were considered to be non-adherent to caFFR.

The study’s primary endpoint was a 3-year major adverse cardiac event (MACE), defined as a composite of cardiovascular mortality, non-fatal myocardial infarction (MI), stroke, and unplanned revascularization.

Out of the total study population, data show PCI was performed in 62.3% of patients. There were a total 26 composite events which occurred during study, including 5 cardiovascular mortality, 5 non-fatal MI, 2 strokes, and 14 unplanned revascularization.

Further, data show the incidence rate of MACE was, in fact, significantly lower in adherent patients, compared to non-adherent patients (5.4% versus 15.8%, P = .01).

Finally, following the multivariate adjustment, patients considered adherent had a significantly lower risk of MACE, compared to non-adherent patients (adjusted hazard ratio, 0.33; 95% CI, 0.13 - 0.83).

In summary, investigators noted that the findings potentially support the use of caFFR in treatment guidance of diabetic patients.

“In stable CAD patients with diabetes, caFFR-guided revascularization significantly reduces the risk of MACE in 3 years,” investigators wrote.

The study, ”3-year Outcomes In Stable Coronary Artery Disease Patients With Diabetes Based On A Novel Index: Computational Pressure-flow Dynamics Derived Fractional Flow Reserve,” was presented at AHA 2021.