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

Jørgensen, Troels Højsgaard ; Engstrøm, Thomas LU ; Jabbari, Reza ; Glinge, Charlotte ; Sabbah, Muhammed ; Veien, Karsten Tange ; Niemela, Matti ; Freeman, Phillip ; Linder, Rickard and Sørensen, Rikke , et al. (2025) In JACC: Cardiovascular Interventions 18(23). p.2925-2936
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... (More)

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.

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Contribution to journal
publication status
published
subject
keywords
aortic valve stenosis, coronary artery disease, fractional flow reserve, transcatheter aortic valve replacement
in
JACC: Cardiovascular Interventions
volume
18
issue
23
pages
12 pages
publisher
Elsevier
external identifiers
  • pmid:41371788
  • scopus:105022922071
ISSN
1936-8798
DOI
10.1016/j.jcin.2025.10.015
language
English
LU publication?
yes
id
37544a82-4ace-4177-9eb0-9fd83b9087da
date added to LUP
2026-01-13 14:55:09
date last changed
2026-01-13 14:55:49
@article{37544a82-4ace-4177-9eb0-9fd83b9087da,
  abstract     = {{<p>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 &gt;0.80 were included in the registry (FFR &gt;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 &gt;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 &gt;0.80 segments ( P &lt; 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 &gt;0.80 lesions, which had similar outcomes. These findings support an FFR threshold of 0.80 to guide coronary revascularization in patients undergoing TAVR.</p>}},
  author       = {{Jørgensen, Troels Højsgaard and Engstrøm, Thomas and Jabbari, Reza and Glinge, Charlotte and Sabbah, Muhammed and Veien, Karsten Tange and Niemela, Matti and Freeman, Phillip and Linder, Rickard and Sørensen, Rikke and Holmvang, Lene and Ioanes, Dan and Terkelsen, Christian Juhl and Ellert-Gregersen, Julia and Christiansen, Evald and Eftekhari, Ashkan and Piuhola, Jarkko and Kajander, Olli and Koul, Sasha and Savontaus, Mikko and Karjalainen, Pasi and Søndergaard, Lars and De Backer, Ole and Lønborg, Jacob}},
  issn         = {{1936-8798}},
  keywords     = {{aortic valve stenosis; coronary artery disease; fractional flow reserve; transcatheter aortic valve replacement}},
  language     = {{eng}},
  number       = {{23}},
  pages        = {{2925--2936}},
  publisher    = {{Elsevier}},
  series       = {{JACC: Cardiovascular Interventions}},
  title        = {{Fractional Flow Reserve to Guide Revascularization in Patients With Coronary Artery Disease Undergoing TAVR}},
  url          = {{http://dx.doi.org/10.1016/j.jcin.2025.10.015}},
  doi          = {{10.1016/j.jcin.2025.10.015}},
  volume       = {{18}},
  year         = {{2025}},
}