The FFR improves outcomes in daily practice as in randomized studies

Original title: Long-term outcomes of fractional flow reserve-guided vs. angiography-guided percutaneous coronary intervention in contemporary practice. Reference: Li J et al. Eur Heart J. 2013; Epub ahead of print

Precision of the fractional flow reserve (FFR) to estimate the functional compromise of coronary stenosis and its ability to reduce events to decide PTCA, based on their outcome has already been established in randomized jobs. 

However, in daily clinical practice using FFR is not protocolar, leaving at surgeon’s discretion the use, according to angiographic findings as well as the decision for PTCA once measurements are performed. This selective use may have different results than randomized trials.

This register conducted at the Mayo Clinic between 2002 and 2009 included 7358 consecutive patients who underwent PCI in that period. Of these, in 6268 patients (85.2%) PTCA was guided only by angiography and the remaining patients 1090 (14.8%) underwent FFR. Overall a FFR <0.75 were indicative of PTCA and was at the discretion of surgeon with measurements between 0.75 and 0.80. After adjusting for baseline characteristics, the 4-year follow-up there was a trend to lower death and myocardial infarction with the use of FFR (RR 0.85, 95% CI: 0.71-1.01, p = 0.06). 

But by excluding patients with measurements between 0.75 and 0.8 the incidence of death and myocardial infarction was significantly lower if the FFR group (RR 0.8, 95% CI: 0.66 to 0.96, p = 0.02). Not perform angioplasty after measuring FFR, significantly reduced both the risk of infarction (p = 0.004) and the combination of death / myocardial infarction (p = 0.02).

Conclusion 

In this record of daily practice we observed a favorable progress at long-term by means of fractional flow reserve to guide or not, the procedure of coronary angioplasty.

Commentary

Other works has shown that routine FFR changes behaviour in 32% of the injuries and in 48% of patients compared to angiography alone, so its use only for angiographically intermediate injuries (as habitually seen in daily practice) could decrease its potential benefit. The reason to perform an analysis excluding patients with measurements between 0.75 and 0.8 was because 40% of them, did not underwent PTCA and today it is clearer that the cut should be in 0.8 (note that most patients were included prior to publication of FAME study). Excluding these patients the benefit is significant and the results are more like those of FAME. The study also shows the long-term safety of not treating the lesions with FFR not significant, it actually resulted in a decrease of events.

SOLACI.ORG

More articles by this author

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

QFR vs. FFR: Is Coronary Revascularization Deferral Safe? Results from a FAVOR III Sub-Analysis

In cases of intermediate coronary lesions, functional assessment is recommended to aid the decision-making process regarding revascularization. There are several tools currently used to...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...