Lipid-lowering therapy is not intensified beyond 3-months if coronary angiography with fractional flow reserve (FFR) suggests non-obstructive coronary disease: a missed opportunity for prevention?

Abstract Background/Introduction Patients with non-obstructive CAD are at risk for future ASCVD events. Coronary angiography FFR distinguishes obstructive from CAD, however, it is unknown how assessment impacts subsequent lipid management in vs CAD. Purpose Examine patterns intensification of lipid-lowering therapy after those Methods Records were reviewed patients a single institution who underwent FFR, instantaneous wave free ratio (iFR), or computed tomographic (CT)-FFR between 2013–2020. Obstructive was defined as presence ≥1 lesion ≤0.8, iFR ≤0.89, CT-FFR by visual assessment. The impact on the atherogenic lipids (LDL-C and non-HDL-C) examined 3, 6, 12 months using Mann-Whitney U test. Results 461 had 338 Most iFR, assessments performed non-ACS indication (n=628 (79%)). Mean (±SD) age 66±11 yrs, 248 (31%) women, 658 (82%) white. Baseline LDL-C similar both groups: 2.2±1.1 mmol/L (obstructive CAD) 2.1±0.9 (non-obstructive CAD). Both groups high baseline statin use (n=349 (76%) n=241 (71%) CAD)). At 3 months, mean non-HDL-C decreased −0.4 mmol/L, mmol/L) −0.3 (p>0.05), number new statins initiated each group. However, 6 increased +0.2 +0.4 mmol/L), while further −0.1 (p=0.011), (p=0.048)). Compared to there more although not statistically significant. remained significantly lower compared (Figure, Table). Conclusions appears prompt short-term (i.e. over months), but this favorable effect lost months. Those likely benefit long-term prevent events, therefore efforts should be made maintain beyond all undergoing Funding Acknowledgement Type funding sources: Private grant(s) and/or Sponsorship. Main source(s): Amgen Investigator Initiated Study