ESC 2018 | FUTURE: A Thorn in FFR and More Questions than Answers

As observed at the preliminary analysis that motivated the FUTURE trial early termination, the use of fractional flow reserve (FFR) to guide revascularization in an unselected population with multivessel disease was associated to twice the mortality rate in one year, with no beneficial impact on other end points.

Even though the combined end point of all-cause mortality, infarction, repeat revascularization or stroke showed no differences at one year between FFR and angiography guided populations (14.6% vs 14.4%; HR 0.97; IC 95% 0.69-1.36), mortality alone resulted 100% higher with FFR (3.7% vs 1.5%; p= 0.036).

All guidelines recommend the use of FFR to guide revascularization, and these results do not show any different. A 3.7% mortality in the FFR Branch is extremely difficult to explain when studies like FAME have showed less than 2%.

The FUTURE outcomes are important, but by no means should they change all we know about the benefits of functional revascularization.

Read also: ESC 2018 | FRANCE-TAVI: Atrial Fibrillation and Anticoagulation Associated to Mortality in TAVR.

Many researchers consider this initial difference might be attributed to chance and that the security committee should not have stopped the study all together.

Original title: Treatment strategy in multivessel coronary disease patients based on fractional flow reserve.

Presenter: Rioufol G ESC Munich Congress.

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