title: Long-term survival in patients undergoing percutaneous interventions with or without intracoronary pressure wire guidance or intracoronary ultrasonographic imaging: a large cohort study.
abstract: OBJECTIVE
  Intracoronary pressure wire-derived measurements of fractional flow reserve (FFR) and intravascular ultrasonography (IVUS) provide functional and anatomical information that can be used to guide coronary stent implantation. Although these devices are widely used and recommended by guidelines, limited data exist about their effect on clinical end points.
  
  
  OBJECTIVE
  To determine the effect on long-term survival of using FFR and IVUS during percutaneous coronary intervention (PCI).
  
  
  METHODS
  Cohort study based on the pan-London (United Kingdom) PCI registry. In total, 64,232 patients are included in this registry covering the London, England, area.
  
  
  METHODS
  All patients (n = 41,688) who underwent elective or urgent PCI in National Health Service hospitals in London between January 1, 2004, and July 31, 2011, were included. Patients with ST-segment elevation myocardial infarction (n = 11,370) were excluded.
  
  
  METHODS
  Patients underwent PCI guided by angiography (visual lesion assessment) alone, PCI guided by FFR, or IVUS-guided PCI.
  
  
  METHODS
  The primary end point was all-cause mortality at a median of 3.3 years.
  
  
  RESULTS
  Fractional flow reserve was used in 2767 patients (6.6%) and IVUS was used in 1831 patients (4.4%). No difference in mortality was observed between patients who underwent angiography-guided PCI compared with patients who underwent FFR-guided PCI (hazard ratio, 0.88; 95% CI, 0.67-1.16; P = .37). Patients who underwent IVUS had a slightly higher adjusted mortality (hazard ratio, 1.39; 95% CI, 1.09-1.78; P = .009) compared with patients who underwent angiography-guided PCI. However, this difference was no longer statistically significant in a propensity score-based analysis (hazard ratio, 1.33; 95% CI, 0.85-2.09; P = .25). The mean (SD) number of implanted stents was lower in the FFR group (1.1 [1.2] stents) compared with the IVUS group (1.6 [1.3]) and the angiography-guided group (1.7 [1.1]) (P < .001).
  
  
  CONCLUSIONS
  In this large observational study, FFR-guided PCI and IVUS-guided PCI were not associated with improved long-term survival compared with standard angiography-guided PCI. The use of FFR was associated with the implantation of fewer stents.
authors: Department of Cardiology, The Heart Hospital, University College London Hospital, London, England.
authors: Georg M
authors: GM
authors: Fröhlich
authors: Department of Cardiology, Guy's and St Thomas' Hospital, London, England.
authors: Simon
authors: S
authors: Redwood
authors: Department of Cardiology, Royal Free Hampstead National Health Service Trust, London, England.
authors: Roby
authors: R
authors: Rakhit
authors: Department of Cardiology, King's College Hospital, London, England.
authors: Philip A
authors: PA
authors: MacCarthy
authors: Department of Cardiology, St George's Hospital, London, England.
authors: Pitt
authors: P
authors: Lim
authors: Department of Cardiology, The Heart Hospital, University College London Hospital, London, England.
authors: Tom
authors: T
authors: Crake
authors: Department of Cardiology, The Heart Hospital, University College London Hospital, London, England.
authors: Steven K
authors: SK
authors: White
authors: Department of Cardiology, Barts Health National Health Service Trust, London, England.
authors: Charles J
authors: CJ
authors: Knight
authors: Department of Statistics, Technische Universität Dortmund, Dortmund, Germany.
authors: Christoph
authors: C
authors: Kustosz
authors: Department of Statistics, Technische Universität Dortmund, Dortmund, Germany.
authors: Guido
authors: G
authors: Knapp
authors: Department of Cardiology, Harefield Hospital, London, England.
authors: Miles C
authors: MC
authors: Dalby
authors: Department of Cardiology, Imperial College Healthcare National Health Service Trust, London, England.
authors: Iqbal S
authors: IS
authors: Mali
authors: Department of Cardiology, Barts Health National Health Service Trust, London, England.
authors: Andrew
authors: A
authors: Archbold
authors: Department of Cardiology, Barts Health National Health Service Trust, London, England.
authors: Andrew
authors: A
authors: Wragg
authors: Department of Cardiology, Barts Health National Health Service Trust, London, England.
authors: Adam D
authors: AD
authors: Timmis
authors: Department of Cardiology, The Heart Hospital, University College London Hospital, London, England.
authors: Pascal
authors: P
authors: Meier
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000628:therapy*; D015331:Cohort Studies; D017023:Coronary Angiography; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008131:London / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016016:Proportional Hazards Models; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D015996:Survival Rate; D018084:Ultrasonography, Interventional / Q000379:methods*