title: Use of fractional flow reserve versus stress perfusion scintigraphy after unstable angina. Effect on duration of hospitalization, cost, procedural characteristics, and clinical outcome.
abstract: OBJECTIVE
  The present study sought to determine the value of fractional flow reserve (FFR) compared with stress perfusion scintigraphy (SPS) in patients with recent unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI).
  
  
  BACKGROUND
  Fractional flow reserve, an invasive index of stenosis severity, is a reliable surrogate for SPS in patients with normal left ventricular function. An FFR > or = 0.75 can distinguish patients after myocardial infarction (MI) with a positive SPS from those with a negative SPS. However, the use of FFR has not been investigated after UA/NSTEMI.
  
  
  METHODS
  Seventy patients who had recent UA/NSTEMI and an intermediate single-vessel stenosis were randomized to either SPS (n = 35) or FFR (n = 35). Patients in the SPS group were discharged if the SPS revealed no ischemia, whereas those in the FFR group were discharged if the FFR was > or = 0.75. Patients with a positive SPS and those with an FFR <0.75 underwent percutaneous transluminal coronary angioplasty. The use of FFR markedly reduced the duration and cost of hospitalization compared with SPS (11 +/- 2 h vs. 49 +/- 5 h [-77%], p < 0.001; and 1,329 US dollars +/- 44 US dollars vs. 2,113 US dollars +/- 120 US dollars, respectively, p < 0.05). There were no significant differences in procedure time, radiation exposure time, or event rates during follow-up, including death, MI, or revascularization.
  
  
  CONCLUSIONS
  These data indicate that: 1) the use of FFR in patients with recent UA/NSTEMI markedly reduces the duration and cost of hospitalization compared with SPS; and 2) these benefits are not associated with an increase in procedure time, radiation exposure time, or clinical event rates.
authors.affiliation: Division of Cardiology, University of Louisville and Jewish Hospital Heart and Lung Institute, Kentucky 40292, USA. malees01@louisville.edu
authors.forename: Massoud A
authors.initials: MA
authors.lastname: Leesar
authors.forename: Talal
authors.initials: T
authors.lastname: Abdul-Baki
authors.forename: Nuri I
authors.initials: NI
authors.lastname: Akkus
authors.forename: Anil
authors.initials: A
authors.lastname: Sharma
authors.forename: Tarif
authors.initials: T
authors.lastname: Kannan
authors.forename: Roberto
authors.initials: R
authors.lastname: Bolli
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D003365:Costs and Cost Analysis; D005080:Exercise Test / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging / Q000191:economics / Q000379:methods; D015899:Tomography, Emission-Computed, Single-Photon