Impact of measuring fractional flow reserve on decision-making in the cath lab in a cohort of patients being considered for coronary revascularization.
BACKGROUND
Fractional flow reserve (FFR) is an accepted standard to detect the functional significance of coronary stenoses. Recent trials suggest that revascularization of moderate coronary stenoses can be safely deferred if the FFR is > or = 0.75 and FFR can be used to guide therapy in multivessel disease.


OBJECTIVE
In a cohort of patients with moderate angiographic coronary disease, we sought to examine the influence of FFR on lesion revascularization and the impact of multivessel FFR assessment on revascularization strategy.


RESULTS
Patients with FFR measurements taken between April 2005 to October 2007 were included. Out of 300 cases performed in this time, 264 patients were included. Patients were 62 +/- 11 years and 1.3 +/- 0.54 vessels were examined per case. 92.7% of lesions with a FFR < 0.75 underwent revascularizati on an d 93% of lesions with a FFR > or = 0.75 had intervention deferred. FFR was 0.71 +/- 0.07 in the revascularization group (9 coronary artery bypass graft surgery, 64 percutaneous coronary interventions) and 0.86 +/- 0.06 in the deferred group (p < 0.001). Overall, 75% of patients avoided revascularization of at least one vessel on the basis of the FFR.


CONCLUSIONS
Measurement of FFR is clinically useful with a high impact on clinical decision-making in the catheterization laboratory. FFR can be used to reclassify patients with multivessel stenoses, reducing the need for revascularization in the majority of cases.
Lockie
Tim
T
The Rayne Institute, 3rd Floor Lambeth Wing, St. Thomas' Hospital, KCL, London, SE1 7EH, United Kingdom. tim.lockie@gstt.nhs.uk
Perera
Divaka
D
De Silva
Kalpa
K
Webb
Ian
I
Pattinson
Suzanne
S
Redwood
Simon
S
D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D015331:Cohort Studies; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D003657:Decision Making; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006334:Heart Function Tests / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012720:Severity of Illness Index; D015607:Stents