Long-term outcomes of fractional flow reserve-guided vs. angiography-guided percutaneous coronary intervention in contemporary practice.
OBJECTIVE
Fractional flow reserve (FFR) is the reference standard for the assessment of the functional significance of coronary artery stenoses, but is underutilized in daily clinical practice. We aimed to study long-term outcomes of FFR-guided percutaneous coronary intervention (PCI) in the general clinical practice.


RESULTS
In this retrospective study, consecutive patients (n = 7358), referred for PCI at the Mayo Clinic between October 2002 and December 2009, were divided in two groups: those undergoing PCI without (PCI-only, n = 6268) or with FFR measurements (FFR-guided, n = 1090). The latter group was further classified as the FFR-Perform group (n = 369) if followed by PCI, and the FFR-Defer group (n = 721) if PCI was deferred. Clinical events were compared during a median follow-up of 50.9 months. The Kaplan-Meier fraction of major adverse cardiac events at 7 years was 57.0% in the PCI-only vs. 50.0% in the FFR-guided group (P = 0.016). Patients with FFR-guided interventions had a non-significantly lower rate of death or myocardial infarction compared with those with angiography-guided interventions [hazard ratio (HR): 0.85, 95% CI: 0.71-1.01, P = 0.06]; the FFR-guided deferred-PCI strategy was independently associated with reduced rate of myocardial infarction (HR: 0.46, 95% CI: 0.26-0.82, P = 0.008). After excluding patients with FFR of 0.75-0.80 and deferring PCI, the use of FFR was significantly associated with reduced rate of death or myocardial infarction (HR: 0.80, 95% CI: 0.66-0.96, P = 0.02).


CONCLUSIONS
In the contemporary practice, an FFR-guided treatment strategy is associated with a favourable long-term outcome. The current study supports the use of the FFR for decision-making in patients undergoing cardiac catheterization.
Division of Cardiology, Xuanwu Hospital Capital Medical University, Beijing 100053, China.
Jing
J
Li
Muhamad Y
MY
Elrashidi
Andreas J
AJ
Flammer
Ryan J
RJ
Lennon
Malcolm R
MR
Bell
David R
DR
Holmes
John F
JF
Bresnahan
Charanjit S
CS
Rihal
Lilach O
LO
Lerman
Amir
A
Lerman
D000368:Aged; D017023:Coronary Angiography / Q000401:mortality; D023921:Coronary Stenosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D015641:Radiography, Interventional / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome
Fractional flow reserve; Outcome; Percutaneous coronary intervention