Abstract
BackgroundFractional 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. Thus, we investigated the outcomes of patients undergoing FFR-guided PCI compared to angiography-guided PCI in a large, state-wide unselected cohort.Methods and resultsAll patients undergoing PCI between June 2017 and June 2018 in New South Wales, Australia, 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 endpoint 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 (hazard ratio [HR] 0.34, 95% confidence intervals [CI] 0.20–0.56, P<0.001), all-cause death (HR 0.18, 95% CI 0.07–0.47, P = 0.001), CVS death (HR 0.21, 95% CI 0.07–0.66, P = 0.01), and MI (HR 0.46, 95% CI 0.25–0.84, 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 (HR 0.45, 95% CI 0.27–0.75, 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 0.09–0.83, P = 0.02).ConclusionsIn this real-world study of patients undergoing PCI, FFR-guidance was associated with lower rates of the primary outcome of death or MI, as well as the secondary outcomes of all-cause death and CVS death.
Highlights
The development of fractional flow reserve (FFR) has improved the assessment and treatment of coronary artery disease in the catheter laboratory
In this real-world study of patients undergoing percutaneous coronary intervention (PCI), FFR-guidance was associated with lower rates of the primary outcome of death or myocardial infarction (MI), as well as the secondary outcomes of allcause death and CVS death
The DEFER (Deferral Versus Performance of PCI of Non-Ischaemia-Producing Stenoses) and DEFER-DES (Proper Fractional Flow Reserve Criteria for Intermediate Lesions in the Era of Drug-Eluting Stent) studies found that coronary lesions with an FFR value 0.75 can be safely deferred and medically managed [1, 2], while the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study demonstrated superiority of FFR-guided PCI over angiography-guided PCI in reducing the combined endpoint of death, myocardial infarction (MI), and repeat revascularization [3]
Summary
The development of fractional flow reserve (FFR) has improved the assessment and treatment of coronary artery disease in the catheter laboratory. Real-world studies comparing outcomes following FFR-guided PCI vs angiography-guided PCI have focused primarily on the US and European population, with no data existing outside of these geographic regions. We performed an analysis on data obtained from a state-wide unselected Australian population to examine clinical outcomes related to FFR-guided PCI in a contemporary PCI cohort. Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has been shown to be superior to angiography-guided PCI in randomized controlled studies. Real-world data on the use and outcomes of FFR-guided PCI remain limited. We investigated the outcomes of patients undergoing FFR-guided PCI compared to angiography-guided PCI in a large, state-wide unselected cohort
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