Original title: Outcome impact of coronary revascularization strategy reclassification with fractional flow reserve at time of diagnostic angiography. Reference: Van Belle E et al. Circulation. 2014 Jan 14;129(2):173-85.
Any comprehensive registry has not been yet published that evaluates the impact of fractional coronary flow reserve (FFR) to change the strategy of revascularization on individual patients referred for diagnostic coronary angiography.
This French registry included 1075 consecutive patients who underwent diagnostic coronary angiography. Researchers were asked to prospectively define the treatment approach according to angiography prior to the completion of FFR. The final treatment approach containing the FFR information as well as the clinical follow- up to one year, was also collected prospectively.
Most patients were stable (80%), while the rest had a history of a heart attack with ST-segment elevation (3%) or myocardial infarction without elevation (17 %) within the previous 15 days.
The a priori strategy based on angiography was: medical treatment in 55% of the population and revascularization in the other 45 % (of these, 38 % coronary angioplasty and 7 % surgery). After performing the FFR, 1028 patients out of 1075 (95.7 %) were treated considering the result.
The strategy considering this information was medical treatment in 58% of the population and revascularization in 42% (32% angioplasty and 10% surgery). The strategy a priori was amended for the FFR information in 43% of patients, specifically in 33% of the time that a priori medical treatment was decided 56% of the time that a priori was angioplasty, and the 51 % of the time that a priori was surgery. In the 464 patients reclassified with FFR information major cardiac events at one year were 11.2% versus 11.9 % (p = 0.78) in those who did not need to be reclassified (those in which the initial strategy remained the same after having the FFR) .
Conclusion:
This study shows that performing the measurement of fractional coronary flow reserve during the diagnostic test, reclassifies revascularization strategy in almost half of patients. It also demonstrates that it is safe to change the decision suggested by conventional angiography.
Editorial comment
A detail to clarify is that an average of 1.32 ± 0.66 lesions were investigated per patient with FFR (no all injuries, not all vessels) which states that our visual estimate over the conventional angiography still has value. Unlike other studies using FFR (including FAME) , in almost all patients (99.2 %) intracoronary bolus adenosine was used instead of a central vein infusion.
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