Fractional Flow Reserve to Guide Revascularization in Patients With Coronary Artery Disease Undergoing TAVR

Troels Højsgaard Jørgensen; Thomas Engstrøm; Reza Jabbari; Charlotte Glinge; Muhammed Sabbah; Karsten Tange Veien; Matti Niemela; Phillip Freeman; Rickard Linder; Rikke Sørensen; Lene Holmvang; Dan Ioanes; Christian Juhl Terkelsen; Julia Ellert-Gregersen; Evald Christiansen; Ashkan Eftekhari; Jarkko Piuhola; Olli Kajander; Sasha Koul; Mikko Savontaus; Pasi Karjalainen; Lars Søndergaard; Ole De Backer; Jacob Lønborg

doi:10.1016/j.jcin.2025.10.015

Fractional Flow Reserve to Guide Revascularization in Patients With Coronary Artery Disease Undergoing TAVR

Troels Højsgaard Jørgensen^*, Thomas Engstrøm, Reza Jabbari, Charlotte Glinge, Muhammed Sabbah, Karsten Tange Veien, Matti Niemela, Phillip Freeman, Rickard Linder, Rikke Sørensen, Lene Holmvang, Dan Ioanes, Christian Juhl Terkelsen, Julia Ellert-Gregersen, Evald Christiansen, Ashkan Eftekhari, Jarkko Piuhola, Olli Kajander, Sasha Koul, Mikko SavontausPasi Karjalainen, Lars Søndergaard, Ole De Backer, Jacob Lønborg

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

3 Citationer (Scopus)

Abstract

Background
The prognostic value of fractional flow reserve (FFR) in assessing coronary stenosis before transcatheter aortic valve replacement (TAVR) is unclear.
Objectives
The aim of this study was to evaluate cardiovascular risks associated with significant and nonsignificant FFR values of coronary stenosis prior to TAVR.
Methods
Patients were enrolled from the NOTION-3 (Nordic Aortic Valve Intervention-3) randomized trial and registry, including those with severe aortic stenosis scheduled for TAVR and ≥50% coronary stenosis. Patients with FFR ≤0.80 or stenosis ≥90% were randomized to conservative therapy (FFR ≤0.80 conservative group) or percutaneous coronary intervention (PCI; FFR ≤0.80 PCI group). Those with FFR >0.80 were included in the registry (FFR >0.80 defer group). Outcomes were cardiovascular death, myocardial infarction, and/or urgent revascularization through 36 months.
Results
Of 587 patients, 232 were in the FFR ≤0.80 conservative group, 220 in the FFR ≤0.80 PCI group, and 135 in the FFR >0.80 defer group. The cumulative incidence rates of cardiovascular death, myocardial infarction, or urgent revascularization were 21.6%, 11.5%, and 10.5%, respectively (P = 0.003). Excess risk in the FFR ≤0.80 conservative group was due mainly to higher myocardial infarction and urgent revascularization rates compared with the other groups. At a coronary lesion level, revascularization occurred in 12.6% of conservatively treated FFR ≤0.80 segments vs 1.3% of PCI-treated FFR ≤0.80 segments and 0.9% of deferred FFR >0.80 segments (P < 0.0001).
Conclusions
Conservative management of FFR ≤0.80 lesions was linked to higher cardiovascular risk compared with either PCI of FFR ≤0.80 lesions or deferral of FFR >0.80 lesions, which had similar outcomes. These findings support an FFR threshold of 0.80 to guide coronary revascularization in patients undergoing TAVR. (Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation [NOTION-3]; NCT03058627)

Originalsprog	Engelsk
Tidsskrift	J A C C: Cardiovascular Interventions
Vol/bind	18
Udgave nummer	23
Sider (fra-til)	2925-2936
Antal sider	12
ISSN	1936-8798
DOI	https://doi.org/10.1016/j.jcin.2025.10.015
Status	Udgivet - 2025

Bibliografisk note

Adgang til dokumentet

10.1016/j.jcin.2025.10.015

Biblioteksadgang?

Tjek tilgængelighed hos det Kgl. Bibliotek

Citationsformater

Jørgensen, T. H., Engstrøm, T., Jabbari, R., Glinge, C., Sabbah, M., Veien, K. T., Niemela, M., Freeman, P., Linder, R., Sørensen, R., Holmvang, L., Ioanes, D., Terkelsen, C. J., Ellert-Gregersen, J., Christiansen, E., Eftekhari, A., Piuhola, J., Kajander, O., Koul, S., ... Lønborg, J. (2025). Fractional Flow Reserve to Guide Revascularization in Patients With Coronary Artery Disease Undergoing TAVR. J A C C: Cardiovascular Interventions, 18(23), 2925-2936. https://doi.org/10.1016/j.jcin.2025.10.015

Jørgensen, TH, Engstrøm, T, Jabbari, R, Glinge, C, Sabbah, M, Veien, KT, Niemela, M, Freeman, P, Linder, R, Sørensen, R, Holmvang, L, Ioanes, D, Terkelsen, CJ, Ellert-Gregersen, J, Christiansen, E, Eftekhari, A, Piuhola, J, Kajander, O, Koul, S, Savontaus, M, Karjalainen, P, Søndergaard, L, De Backer, O & Lønborg, J 2025, 'Fractional Flow Reserve to Guide Revascularization in Patients With Coronary Artery Disease Undergoing TAVR', J A C C: Cardiovascular Interventions, bind 18, nr. 23, s. 2925-2936. https://doi.org/10.1016/j.jcin.2025.10.015

@article{3328ecda01e94064ab7dc6014d157493,

title = "Fractional Flow Reserve to Guide Revascularization in Patients With Coronary Artery Disease Undergoing TAVR",

abstract = "BACKGROUND: The prognostic value of fractional flow reserve (FFR) in assessing coronary stenosis before transcatheter aortic valve replacement (TAVR) is unclear.OBJECTIVES: The aim of this study was to evaluate cardiovascular risks associated with significant and nonsignificant FFR values of coronary stenosis prior to TAVR.METHODS: Patients were enrolled from the NOTION-3 (Nordic Aortic Valve Intervention-3) randomized trial and registry, including those with severe aortic stenosis scheduled for TAVR and ≥50% coronary stenosis. Patients with FFR ≤0.80 or stenosis ≥90% were randomized to conservative therapy (FFR ≤0.80 conservative group) or percutaneous coronary intervention (PCI; FFR ≤0.80 PCI group). Those with FFR >0.80 were included in the registry (FFR >0.80 defer group). Outcomes were cardiovascular death, myocardial infarction, and/or urgent revascularization through 36 months.RESULTS: Of 587 patients, 232 were in the FFR ≤0.80 conservative group, 220 in the FFR ≤0.80 PCI group, and 135 in the FFR >0.80 defer group. The cumulative incidence rates of cardiovascular death, myocardial infarction, or urgent revascularization were 21.6%, 11.5%, and 10.5%, respectively (P = 0.003). Excess risk in the FFR ≤0.80 conservative group was due mainly to higher myocardial infarction and urgent revascularization rates compared with the other groups. At a coronary lesion level, revascularization occurred in 12.6% of conservatively treated FFR ≤0.80 segments vs 1.3% of PCI-treated FFR ≤0.80 segments and 0.9% of deferred FFR >0.80 segments (P < 0.0001).CONCLUSIONS: Conservative management of FFR ≤0.80 lesions was linked to higher cardiovascular risk compared with either PCI of FFR ≤0.80 lesions or deferral of FFR >0.80 lesions, which had similar outcomes. These findings support an FFR threshold of 0.80 to guide coronary revascularization in patients undergoing TAVR. (Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation [NOTION-3]; NCT03058627).",

keywords = "Humans, Fractional Flow Reserve, Myocardial, Male, Female, Transcatheter Aortic Valve Replacement/adverse effects, Aortic Valve Stenosis/physiopathology, Aged, Percutaneous Coronary Intervention/adverse effects, Treatment Outcome, Time Factors, Risk Factors, Registries, Aged, 80 and over, Coronary Stenosis/physiopathology, Coronary Artery Disease/physiopathology, Predictive Value of Tests, Severity of Illness Index, Risk Assessment, Conservative Treatment/adverse effects, Clinical Decision-Making, Prospective Studies, Myocardial Infarction/etiology",

author = "J{\o}rgensen, {Troels H{\o}jsgaard} and Thomas Engstr{\o}m and Reza Jabbari and Charlotte Glinge and Muhammed Sabbah and Veien, {Karsten Tange} and Matti Niemela and Phillip Freeman and Rickard Linder and Rikke S{\o}rensen and Lene Holmvang and Dan Ioanes and Terkelsen, {Christian Juhl} and Julia Ellert-Gregersen and Evald Christiansen and Ashkan Eftekhari and Jarkko Piuhola and Olli Kajander and Sasha Koul and Mikko Savontaus and Pasi Karjalainen and Lars S{\o}ndergaard and {De Backer}, Ole and Jacob L{\o}nborg",

year = "2025",

doi = "10.1016/j.jcin.2025.10.015",

language = "English",

volume = "18",

pages = "2925--2936",

journal = "J A C C: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier",

number = "23",

}

TY - JOUR

T1 - Fractional Flow Reserve to Guide Revascularization in Patients With Coronary Artery Disease Undergoing TAVR

AU - Jørgensen, Troels Højsgaard

AU - Engstrøm, Thomas

AU - Jabbari, Reza

AU - Glinge, Charlotte

AU - Sabbah, Muhammed

AU - Veien, Karsten Tange

AU - Niemela, Matti

AU - Freeman, Phillip

AU - Linder, Rickard

AU - Sørensen, Rikke

AU - Holmvang, Lene

AU - Ioanes, Dan

AU - Terkelsen, Christian Juhl

AU - Ellert-Gregersen, Julia

AU - Christiansen, Evald

AU - Eftekhari, Ashkan

AU - Piuhola, Jarkko

AU - Kajander, Olli

AU - Koul, Sasha

AU - Savontaus, Mikko

AU - Karjalainen, Pasi

AU - Søndergaard, Lars

AU - De Backer, Ole

AU - Lønborg, Jacob

PY - 2025

Y1 - 2025

N2 - BACKGROUND: The prognostic value of fractional flow reserve (FFR) in assessing coronary stenosis before transcatheter aortic valve replacement (TAVR) is unclear.OBJECTIVES: The aim of this study was to evaluate cardiovascular risks associated with significant and nonsignificant FFR values of coronary stenosis prior to TAVR.METHODS: Patients were enrolled from the NOTION-3 (Nordic Aortic Valve Intervention-3) randomized trial and registry, including those with severe aortic stenosis scheduled for TAVR and ≥50% coronary stenosis. Patients with FFR ≤0.80 or stenosis ≥90% were randomized to conservative therapy (FFR ≤0.80 conservative group) or percutaneous coronary intervention (PCI; FFR ≤0.80 PCI group). Those with FFR >0.80 were included in the registry (FFR >0.80 defer group). Outcomes were cardiovascular death, myocardial infarction, and/or urgent revascularization through 36 months.RESULTS: Of 587 patients, 232 were in the FFR ≤0.80 conservative group, 220 in the FFR ≤0.80 PCI group, and 135 in the FFR >0.80 defer group. The cumulative incidence rates of cardiovascular death, myocardial infarction, or urgent revascularization were 21.6%, 11.5%, and 10.5%, respectively (P = 0.003). Excess risk in the FFR ≤0.80 conservative group was due mainly to higher myocardial infarction and urgent revascularization rates compared with the other groups. At a coronary lesion level, revascularization occurred in 12.6% of conservatively treated FFR ≤0.80 segments vs 1.3% of PCI-treated FFR ≤0.80 segments and 0.9% of deferred FFR >0.80 segments (P < 0.0001).CONCLUSIONS: Conservative management of FFR ≤0.80 lesions was linked to higher cardiovascular risk compared with either PCI of FFR ≤0.80 lesions or deferral of FFR >0.80 lesions, which had similar outcomes. These findings support an FFR threshold of 0.80 to guide coronary revascularization in patients undergoing TAVR. (Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation [NOTION-3]; NCT03058627).

AB - BACKGROUND: The prognostic value of fractional flow reserve (FFR) in assessing coronary stenosis before transcatheter aortic valve replacement (TAVR) is unclear.OBJECTIVES: The aim of this study was to evaluate cardiovascular risks associated with significant and nonsignificant FFR values of coronary stenosis prior to TAVR.METHODS: Patients were enrolled from the NOTION-3 (Nordic Aortic Valve Intervention-3) randomized trial and registry, including those with severe aortic stenosis scheduled for TAVR and ≥50% coronary stenosis. Patients with FFR ≤0.80 or stenosis ≥90% were randomized to conservative therapy (FFR ≤0.80 conservative group) or percutaneous coronary intervention (PCI; FFR ≤0.80 PCI group). Those with FFR >0.80 were included in the registry (FFR >0.80 defer group). Outcomes were cardiovascular death, myocardial infarction, and/or urgent revascularization through 36 months.RESULTS: Of 587 patients, 232 were in the FFR ≤0.80 conservative group, 220 in the FFR ≤0.80 PCI group, and 135 in the FFR >0.80 defer group. The cumulative incidence rates of cardiovascular death, myocardial infarction, or urgent revascularization were 21.6%, 11.5%, and 10.5%, respectively (P = 0.003). Excess risk in the FFR ≤0.80 conservative group was due mainly to higher myocardial infarction and urgent revascularization rates compared with the other groups. At a coronary lesion level, revascularization occurred in 12.6% of conservatively treated FFR ≤0.80 segments vs 1.3% of PCI-treated FFR ≤0.80 segments and 0.9% of deferred FFR >0.80 segments (P < 0.0001).CONCLUSIONS: Conservative management of FFR ≤0.80 lesions was linked to higher cardiovascular risk compared with either PCI of FFR ≤0.80 lesions or deferral of FFR >0.80 lesions, which had similar outcomes. These findings support an FFR threshold of 0.80 to guide coronary revascularization in patients undergoing TAVR. (Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation [NOTION-3]; NCT03058627).

KW - Humans

KW - Fractional Flow Reserve, Myocardial

KW - Male

KW - Female

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Aortic Valve Stenosis/physiopathology

KW - Aged

KW - Percutaneous Coronary Intervention/adverse effects

KW - Treatment Outcome

KW - Time Factors

KW - Risk Factors

KW - Registries

KW - Aged, 80 and over

KW - Coronary Stenosis/physiopathology

KW - Coronary Artery Disease/physiopathology

KW - Predictive Value of Tests

KW - Severity of Illness Index

KW - Risk Assessment

KW - Conservative Treatment/adverse effects

KW - Clinical Decision-Making

KW - Prospective Studies

KW - Myocardial Infarction/etiology

U2 - 10.1016/j.jcin.2025.10.015

DO - 10.1016/j.jcin.2025.10.015

M3 - Journal article

C2 - 41371788

SN - 1936-8798

VL - 18

SP - 2925

EP - 2936

JO - J A C C: Cardiovascular Interventions

JF - J A C C: Cardiovascular Interventions

IS - 23

ER -