The safety profile of deferred revascularization in patients with coronary artery disease undergoing non-hyperemic functional assessments.

INTRODUCTION

Fractional flow reserve (FFR) remains the gold standard for functional evaluation in coronary artery disease (CAD). However, non-hyperemic indices, such as diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR), are increasingly utilized in clinical practice. Data on the safety and long-term outcomes of deferred revascularization based on these indices remain limited.

AIM

This study aimed to evaluate the safety of deferred revascularization in patients with CAD using dPR and RFR indices.

MATERIAL AND METHODS

Between January and June 2022, all consecutive patients undergoing functional coronary evaluations at a large tertiary hospital were screened. Primary endpoints included major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction (MI), and target vessel revascularization (TVR), along with individual endpoints at 1-year follow-up.

RESULTS

Of 321 patients evaluated, 290 met the eligibility criteria, and 204 underwent deferred revascularization based on non-hyperemic assessments. The cohort had a mean age of 68.2 years (SD ±8.9), with 76.8% male. Chronic coronary syndrome (57.2%), unstable angina (13.8%), and heart failure (9.3%) were the primary indications for coronary angiography. Among 230 lesions assessed with dPR and 243 with RFR, positive findings were observed in 17.4% and 13.2%, respectively ( = 0.15). At 1-year follow-up, MACE occurred in 7.8%, all-cause mortality was 4.9%, MI was 0.5%, and TVR was 2.5%.

CONCLUSIONS

Deferred revascularization guided by dPR and RFR appears safe, with outcomes comparable to FFR-guided decisions in the literature. Larger randomized trials are needed to confirm these findings.