Risk model for estimating the 1-year risk of deferred lesion intervention following deferred revascularization after fractional flow reserve assessment

Eur Heart J. 2015 Feb 21;36(8):509-15. doi: 10.1093/eurheartj/ehu412. Epub 2014 Oct 21.


Aims: Although lesions deferred revascularization following fractional flow reserve (FFR) assessment have a low risk of adverse cardiac events, variability in risk for deferred lesion intervention (DLI) has not been previously evaluated. The aim of this study was to develop a prediction model to estimate 1-year risk of DLI for coronary lesions where revascularization was not performed following FFR assessment.

Methods and results: A prediction model for DLI was developed from a cohort of 721 patients with 882 coronary lesions where revascularization was deferred based on FFR between 10/2002 and 7/2010. Deferred lesion intervention was defined as any revascularization of a lesion previously deferred following FFR. The final DLI model was developed using stepwise Cox regression and validated using bootstrapping techniques. An algorithm was constructed to predict the 1-year risk of DLI. During a mean (±SD) follow-up period of 4.0 ± 2.3 years, 18% of lesions deferred after FFR underwent DLI; the 1-year incidence of DLI was 5.3%, while the predicted risk of DLI varied from 1 to 40%. The final Cox model included the FFR value, age, current or former smoking, history of coronary artery disease (CAD) or prior percutaneous coronary intervention, multi-vessel CAD, and serum creatinine. The c statistic for the DLI prediction model was 0.66 (95% confidence interval, CI: 0.61-0.70).

Conclusion: Patients deferred revascularization based on FFR have variation in their risk for DLI. A clinical prediction model consisting of five clinical variables and the FFR value can help predict the risk of DLI in the first year following FFR assessment.

Keywords: Deferred lesion intervention; Fractional flow reserve.

MeSH terms

  • Cohort Studies
  • Coronary Artery Bypass
  • Coronary Artery Disease / physiopathology
  • Coronary Artery Disease / therapy*
  • Fractional Flow Reserve, Myocardial / physiology
  • Humans
  • Male
  • Middle Aged
  • Myocardial Revascularization*
  • Percutaneous Coronary Intervention
  • Risk Assessment
  • Time Factors
  • Treatment Outcome