Kang DY, et al. - Researchers assessed the prognosis for deferred and performed revascularization in coronary stenosis with fractional flow reserve (FFR) values in the grey zone (0.75–0.80). They found that there was no association of revascularization with better clinical outcomes for coronary stenosis with grey-zone FFR. In addition, they noted that the higher likelihood of periprocedural myocardial infarction (MI) with revascularization was offset by the higher likelihood of target vessel revascularization (TVR) with deferral.

• From the prospective multicentre Interventional Cardiology Research In-cooperation Society Fractional Flow Reserve registry, researchers examined a total of 1334 native coronary stenosis with grey-zone FFR values in 1334 patients.

• Data showed that revascularization was deferred for 683 patients (deferred group) and performed for 651 (performed group).
• During a median follow-up of 2.9 years (interquartile range 1.5–4.1 years), occurrence of the primary outcome, a composite of death, target-vessel myocardial infarction (MI), and target vessel revascularization (TVR) was noted in 55 (8.1%) patients in the deferred group and 55 (8.4%) in the performed group [adjusted hazard ratio (aHR) 1.05, 95% confidence interval (CI) 0.67–1.66; P=0.79].
• Findings demonstrated no difference between the groups in terms of overall mortality and spontaneous MI (mortality 2.5% vs 2.0%; aHR 0.82, 95% CI 0.34–2.00; P=0.66; spontaneous MI 0.7% vs 0.5%; aHR 1.85, 95% CI 0.35–9.75; P=0.47).
• Researchers found significantly higher myocardial infarction in the performed group (0.7% vs 3.2%; aHR 0.27, 95% CI 0.09–0.80; P=0.02) predominately attributed to a higher risk of periprocedural MI.
• In addition, they noted that target vessel revascularization was significantly higher in the deferred group (5.7% vs 3.7%; aHR 2.17, 95% CI 1.17–4.02; P=0.01).