title: Thirty-month outcome after fractional flow reserve-guided versus conventional multivessel percutaneous coronary intervention.
abstract: We investigated the value of fractional flow reserve (FFR)-guided percutaneous coronary intervention (FFR-PCI) versus conventional PCI in patients with multivessel disease (MVD). Conventional PCI is performed by visual estimation of the stenosis. Deferral of PCI because of a FFR >or=0.75 is associated with low event rates. However, the value of FFR-PCI in patients with MVD is unknown. We prospectively enrolled 137 patients (312 vessels) with MVD to compare FFR-PCI and conventional PCI. In the FFR-PCI group, FFR of all vessels was performed, and PCI of stenoses with a FFR <0.75 was performed. In the conventional PCI group, patients underwent multivessel PCI by visual estimation of the stenoses. Procedural characteristics, event rates, and cost were compared between the 2 groups. In the FFR-PCI group, after FFR analysis in 57 patients (128 vessels), PCI was performed in 48 patients (53 vessels). In the conventional PCI group, 80 patients (184 vessels) underwent PCI. The average number of vessels per patient that underwent PCI and the cost of procedure were significantly greater in the conventional PCI group than in the FFR-PCI group (2.27 +/- 0.50 vs 1.12 +/- 0.30 vessels and 3,167 dollars +/- 1,194 dollars vs 2,572 dollars +/- 934 dollars, respectively; p <0.001). The 30-month Kaplan-Meier event-free survival estimate was significantly higher in the FFR-PCI group than in the conventional PCI group (89% vs 59%, p <0.01). In conclusion, the results of the present study have demonstrated that in patients with MVD, compared with conventional PCI, FFR-PCI significantly reduces the number of vessels undergoing PCI, the event rate, and the cost of the procedure.
authors.affiliation: Division of Cardiology, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Nattawut
authors.initials: N
authors.lastname: Wongpraparut
authors.forename: Vankata
authors.initials: V
authors.lastname: Yalamanchili
authors.forename: Venkat
authors.initials: V
authors.lastname: Pasnoori
authors.forename: Aaron
authors.initials: A
authors.lastname: Satran
authors.forename: Mukul
authors.initials: M
authors.lastname: Chandra
authors.forename: Ronald
authors.initials: R
authors.lastname: Masden
authors.forename: Massoud A
authors.initials: MA
authors.lastname: Leesar
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics / Q000379:methods; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003365:Costs and Cost Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged