Objective:

To evaluate the association between nonischemic resting full-cycle ratio (RFR) values and cardiovascular outcomes, particularly focusing on repeat revascularization rates.

Approach:

• Study Design: A single-center observational study involving 773 patients with 1,012 angiographically intermediate coronary lesions, assessing outcomes after deferring revascularization based on RFR values.
• Patient Stratification: Patients were stratified into three groups based on RFR values: below 0.93, 0.93 to 0.95, and greater than 0.95.
• Outcome Measures: Primary outcome was the 2-year incidence of major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, vessel-oriented composite outcomes, and repeat revascularization.

Key Findings:

• At 2 years, the lesion-based MACE rate was 8%, with no significant differences across the RFR groups.
• Patients with RFR values below 0.93 had a higher likelihood of repeat revascularization, approximately three times more likely for target-vessel revascularization.
• Older age, chronic obstructive pulmonary disease, peripheral artery disease, atrial fibrillation, diffuse coronary artery disease, and heavy coronary calcification were associated with higher MACE rates.

Interpretation:

Limitations:

• Single-center observational design limits generalizability and may introduce residual confounding.
• Some deaths could not be definitively attributed to the deferred lesion.
• Small number of patients with RFR values below 0.93 and low event rates may affect precision.

Conclusion:

Sources:

• Clinical Research in Cardiology