TY - JOUR
T1 - Long-term outcomes of fractional flow reserve-guided vs. angiography-guided percutaneous coronary intervention in contemporary practice
AU - Li, Jing
AU - Elrashidi, Muhamad Y.
AU - Flammer, Andreas J.
AU - Lennon, Ryan J.
AU - Bell, Malcolm R.
AU - Holmes, David R.
AU - Bresnahan, John F.
AU - Rihal, Charanjit S.
AU - Lerman, Lilach O.
AU - Lerman, Amir
N1 - Funding Information:
National Institute of Health (NIH Grant HL-92954 and AG-31750 to A.L.). The study was also supported by an unrestricted grant from St Jude Medical. J.L. was supported by the China Scholarship Council (NO.2010811095), and ‘Beijing Nova program’ of Beijing Municipal Science & Technology Commission (A2007079), China. A.J.F. was supported by the Walter and Gertrud Siegenthaler Foundation, the Young Academics Support Committee of the University of Zurich, and the Swiss foundation for Medical-Biological Scholarships (SSMBS; SNSF No PASMP3_132551). L.O.L. has received financial support through an institutional grant from the NIH.
Funding Information:
Conflict of interest: L.O.L. has also received honorarium from the NIH. She has also been employed by the NIH. With regard to financial activities outside the submitted work, she has been employed by the NIH and has received research grant support from Stealth Peptides, Inc. She has also been awarded a post doc fellowship by the AHA. In addition, she has received institutional financial support for pending patents, and has also received support for accommodation at international scientific meetings from other academic institutions. With regard to financial activities outside the submitted work, A.L.
PY - 2013/5/7
Y1 - 2013/5/7
N2 - AimsFractional flow reserve (FFR) is the reference standard for the assessment of the functional significance of coronary artery stenoses, but is underutilized in daily clinical practice. We aimed to study long-term outcomes of FFR-guided percutaneous coronary intervention (PCI) in the general clinical practice.Methods and resultsIn this retrospective study, consecutive patients (n = 7358), referred for PCI at the Mayo Clinic between October 2002 and December 2009, were divided in two groups: those undergoing PCI without (PCI-only, n = 6268) or with FFR measurements (FFR-guided, n = 1090). The latter group was further classified as the FFR-Perform group (n = 369) if followed by PCI, and the FFR-Defer group (n = 721) if PCI was deferred. Clinical events were compared during a median follow-up of 50.9 months. The Kaplan-Meier fraction of major adverse cardiac events at 7 years was 57.0% in the PCI-only vs. 50.0% in the FFR-guided group (P = 0.016). Patients with FFR-guided interventions had a non-significantly lower rate of death or myocardial infarction compared with those with angiography-guided interventions [hazard ratio (HR): 0.85, 95% CI: 0.71-1.01, P = 0.06]; the FFR-guided deferred-PCI strategy was independently associated with reduced rate of myocardial infarction (HR: 0.46, 95% CI: 0.26-0.82, P = 0.008). After excluding patients with FFR of 0.75-0.80 and deferring PCI, the use of FFR was significantly associated with reduced rate of death or myocardial infarction (HR: 0.80, 95% CI: 0.66-0.96, P = 0.02).ConclusionIn the contemporary practice, an FFR-guided treatment strategy is associated with a favourable long-term outcome. The current study supports the use of the FFR for decision-making in patients undergoing cardiac catheterization.
AB - AimsFractional flow reserve (FFR) is the reference standard for the assessment of the functional significance of coronary artery stenoses, but is underutilized in daily clinical practice. We aimed to study long-term outcomes of FFR-guided percutaneous coronary intervention (PCI) in the general clinical practice.Methods and resultsIn this retrospective study, consecutive patients (n = 7358), referred for PCI at the Mayo Clinic between October 2002 and December 2009, were divided in two groups: those undergoing PCI without (PCI-only, n = 6268) or with FFR measurements (FFR-guided, n = 1090). The latter group was further classified as the FFR-Perform group (n = 369) if followed by PCI, and the FFR-Defer group (n = 721) if PCI was deferred. Clinical events were compared during a median follow-up of 50.9 months. The Kaplan-Meier fraction of major adverse cardiac events at 7 years was 57.0% in the PCI-only vs. 50.0% in the FFR-guided group (P = 0.016). Patients with FFR-guided interventions had a non-significantly lower rate of death or myocardial infarction compared with those with angiography-guided interventions [hazard ratio (HR): 0.85, 95% CI: 0.71-1.01, P = 0.06]; the FFR-guided deferred-PCI strategy was independently associated with reduced rate of myocardial infarction (HR: 0.46, 95% CI: 0.26-0.82, P = 0.008). After excluding patients with FFR of 0.75-0.80 and deferring PCI, the use of FFR was significantly associated with reduced rate of death or myocardial infarction (HR: 0.80, 95% CI: 0.66-0.96, P = 0.02).ConclusionIn the contemporary practice, an FFR-guided treatment strategy is associated with a favourable long-term outcome. The current study supports the use of the FFR for decision-making in patients undergoing cardiac catheterization.
KW - Fractional flow reserve
KW - Outcome
KW - Percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=84877751479&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84877751479&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/eht005
DO - 10.1093/eurheartj/eht005
M3 - Article
C2 - 23344979
AN - SCOPUS:84877751479
SN - 0195-668X
VL - 34
SP - 1375
EP - 1383
JO - European heart journal
JF - European heart journal
IS - 18
ER -