title: Fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery.
abstract: BACKGROUND
  Fractional flow reserve (FFR) is well established for patients undergoing percutaneous coronary intervention, yet little is known about candidates for coronary artery bypass graft surgery.
  
  
  RESULTS
  From 2006 to 2010, we retrospectively included in this registry 627 consecutive patients treated by coronary artery bypass graft surgery having at least 1 angiographically intermediate stenosis. In 429 patients, coronary artery bypass graft surgery was based solely on angiography (angiography-guided group). In 198 patients, at least 1 intermediate stenosis was grafted with an FFR ≤0.80 or deferred with an FFR >0.80 (FFR-guided group). The end point was major adverse cardiovascular events at 3 years, defined as the composite of overall death, myocardial infarction, and target vessel revascularization. The rate of angiographic multivessel disease was similar in the angiography-guided and FFR-guided groups (404 [94.2%] versus 186 [93.9%]; P=0.722). In the FFR-guided group, this was significantly downgraded after FFR measurements to 86.4% (P<0.001 versus before FFR) and was associated with a smaller number of anastomoses (3 [2-3] versus 3 [2-4]; P<0.001) and rate of on-pump surgery (49% versus 69%; P<0.001). At 3 years, major adverse cardiovascular events were not different between the angiography-guided and FFR-guided groups (12% versus 11%; hazard ratio, 1.030; 95% confidence interval, 0.627-1.692; P=0.908). However, the FFR-guided group compared with the angiography-guided group presented a significantly lower rate of angina (Canadian Cardiovascular Society class II-IV, 31% versus 47%; P<0.001).
  
  
  CONCLUSIONS
  FFR-guided coronary artery bypass graft surgery was associated with a lower number of graft anastomoses and a lower rate of on-pump surgery compared with angiography-guided coronary artery bypass graft surgery. This did not result in a higher event rate during up to 36 months of follow-up and was associated with a lower rate of angina.
authors.affiliation: Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
authors.forename: Gabor
authors.initials: G
authors.lastname: Toth
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.forename: Filip
authors.initials: F
authors.lastname: Casselman
authors.forename: Frederic
authors.initials: F
authors.lastname: De Vroey
authors.forename: Stylianos
authors.initials: S
authors.lastname: Pyxaras
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Serafino
authors.forename: Frank
authors.initials: F
authors.lastname: Van Praet
authors.forename: Carlos
authors.initials: C
authors.lastname: Van Mieghem
authors.forename: Bernard
authors.initials: B
authors.lastname: Stockman
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.forename: Ivan
authors.initials: I
authors.lastname: Degrieck
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies
keywords: coronary angiography; coronary artery bypass; coronary artery disease; fractional flow reserve