title: Fractional Flow Reserve Guided Percutaneous Coronary Intervention Improves Clinical Outcome with Reduced Cost in Contemporary Clinical Practice.
abstract: BACKGROUND
  Fractional flow reserve (FFR) is currently considered as the gold standard for evaluating the functional significance of coronary stenosis. However, its potential benefits in real-world practice remain unknown in China. This study aimed to test the hypothesis that the use of FFR is associated with improved outcome and reduced cost in Chinese real-world clinical practice.
  
  
  METHODS
  A retrospective cohort study was carried out using the database of Second Affiliated Hospital of Zhejiang University, a tertiary and high-volume center in China. Clinical events were compared using the Cox proportional hazards model during a median follow-up of 13 months.
  
  
  RESULTS
  The study cohort consisted of 366 consecutive patients referred for coronary revascularization with adjunct FFR and 366 matched controls, from 2010 to 2014. Major adverse cardiac events (MACEs) (death, myocardial infarction, repeated revascularization, or hospitalization for angina) at 4 years were found in 12.0% of angiography-guided patients and 4.9% in the FFR-guided group (P < 0.001). The mean number of implanted stents was significantly lower in FFR treated subjects (0.52 ± 0.82 stents) compared with the angiography-guided group (0.93 ± 0.96 stents) (P < 0.001). No difference in overall costs at initial hospitalization was observed between angiography-guided percutaneous coronary intervention (PCI) compared with FFR-guided PCI (RMB 33,000 Yuan, range: RMB 7393-44,700 Yuan) versus RMB 21,200 Yuan (RMB 19,100-47,100 Yuan) (P = 0.54). However, costs for MACEs during follow-up were significantly reduced in the FFR-guided arm (P < 0.001).
  
  
  CONCLUSIONS
  In the contemporary clinical practice, FFR-guided PCI is associated with decreased use of stents, improved clinical outcome, and reduced costs, compared with angiography-guided PCI.
authors.forename: Po
authors.initials: P
authors.lastname: Hu
authors.forename: Meng-Yao
authors.initials: MY
authors.lastname: Tang
authors.forename: Wen-Chao
authors.initials: WC
authors.lastname: Song
authors.forename: Jun
authors.initials: J
authors.lastname: Jiang
authors.forename: Yong
authors.initials: Y
authors.lastname: Sun
authors.forename: Xian-Bao
authors.initials: XB
authors.lastname: Liu
authors.forename: Chang-Ling
authors.initials: CL
authors.lastname: Li
authors.forename: Xin-Yang
authors.initials: XY
authors.lastname: Hu
authors.affiliation: Department of Cardiology, Second Affiliated Hospital, College of Medicine; Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China.
authors.forename: Jian-An
authors.initials: JA
authors.lastname: Wang
mesh_terms: D000368:Aged; D002681:China; D003365:Costs and Cost Analysis; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000191:economics* / Q000379:methods*; D012189:Retrospective Studies