279 A Real-World Comparison of Outcomes between Fractional Flow Reserve-guided Versus Angiography-Guided Percutaneous Coronary Intervention

Abstract

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has been shown to be superior to angiography-guided PCI in randomized controlled studies. However, real-world data on the use and outcomes of FFR-guided PCI remain limited. To investigate the outcomes of patients undergoing FFR-guided PCI compared to angiography-guided PCI in a large, state-wide unselected cohort. All patients undergoing PCI between June 2017 and June 2018 in the state of New South Wales were included. The cohort was stratified into the FFR-guided group when concomitant FFR was performed, and the angiography-guided group when no FFR was performed. The primary outcome was a combined end-point of death or myocardial infarction (MI). Secondary outcomes included all-cause death, cardiovascular (CVS) death, and MI. The cohort comprised 10,304 patients, of which 542 (5%) underwent FFR-guided PCI. During a mean follow-up of 12±4 months, the FFR-guided PCI group had reduced occurrence of the primary outcome (3% vs 8%, p<0.001), all-cause death (1% vs 4%, p=0.001), CVS death (1% vs 3%, p=0.003), and MI (2% vs 4%, p=0.01) compared to the angiography-guided PCI group. Multivariable Cox regression analysis showed FFR-guidance to be an independent predictor of the primary outcome (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.26-0.74, p=0.002), all-cause death (HR 0.22, 95% CI 0.08-0.59, p=0.003), and CVS death (HR 0.27, 95% CI 0.09-0.85, p=0.03). In this real-world study of patients undergoing PCI, FFR-guidance was associated with improved clinical outcomes, driven by lower rates of death or MI.