Reclassification of Treatment Strategy with Fractional Flow Reserve in Cancer Patients with Coronary Artery Disease

Jin Wan Kim, Tariq J. Dayah, Awad Javaid, Dominique J. Monlezun, Dinu V. Balanescu, Teodora Donisan, Kaveh Karimzad, Abdul Hakeem, David L. Boone, Nicolas Palaskas, Juan Lopez-Mattei, Peter Y. Kim, Jean Bernard Durand, Juhee Song, Serban M. Balanescu, Eric H. Yang, Joerg Herrmann, Konstantinos Marmagkiolis, Konstantinos Toutouzas, Nils P. JohnsonCezar A. Iliescu

Research output: Contribution to journalArticlepeer-review


Background and Objectives: Cancer and coronary artery disease (CAD) often coexist. Compared to quantitative coronary angiography (QCA), fractional flow reserve (FFR) has emerged as a more reliable method of identifying significant coronary stenoses. We aimed to assess the specific management, safety and outcomes of FFR-guided percutaneous coronary intervention (PCI) in cancer patients with stable CAD. Materials and Methods: FFR was used to assess cancer patients that underwent coronary angiography for stable CAD between September 2008 and May 2016, and were found to have ≥50% stenosis by QCA. Patients with lesions with an FFR > 0.75 received medical therapy alone, while those with FFR ≤ 0.75 were revascularized. Procedure-related complications, all-cause mortality, nonfatal myocardial infarction, or urgent revascularizations were analyzed. Results: Fifty-seven patients with stable CAD underwent FFR on 57 lesions. Out of 31 patients with ≥70% stenosis as measured by QCA, 14 (45.1%) had an FFR ≥ 0.75 and lesions were reclassified as moderate and did not receive PCI nor DAPT. Out of 26 patients with <70% stenosis as measured by QCA, 6 (23%) had an FFR < 0.75 and were reclassified as severe and were treated with PCI and associated DAPT. No periprocedural complications, urgent revascularization, acute coronary syndromes, or cardiovascular deaths were noted. There was a 22.8% mortality at 1 year, all cancer related. Patients who received a stent by FFR assessment showed a significant association with decreased risk of all-cause death (HR: 0.37, 95% CI 0.15–0.90, p = 0.03). Conclusions: Further studies are needed to define the optimal therapeutic approach for cancer patients with CAD. Using an FFR cut-off point of 0.75 to guide PCI translates into fewer interventions and can facilitate cancer care. There was an overall reduction in mortality in patients that received a stent, suggesting increased resilience to cancer therapy and progression.

Original languageEnglish (US)
Article number884
JournalMedicina (Lithuania)
Issue number7
StatePublished - Jul 2022


  • cardio-oncology
  • coronary artery disease
  • fractional flow reserve
  • percutaneous coronary intervention
  • quantitative coronary angiography

ASJC Scopus subject areas

  • Medicine(all)


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