ArticleEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2026
Clinical outcomes of FFR-guided revascularisation of non-culprit lesions in NSTE-ACS.
Article in EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe role of fractional flow reserve (FFR)-guided revascularisation in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is unclear.
aimsWe sought to compare the outcomes of FFR-guided and angiography-guided revascularisation in patients with NSTE-ACS and chronic coronary syndrome (CCS).
methodsIndividual 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.
resultsOverall, 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.
conclusionsFFR-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.
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