title: Fractional Flow Reserve-Guided Revascularization in Patients With Aortic Stenosis.
abstract: Fractional flow reserve (FFR) has never been investigated in patients with aortic stenosis (AS). From 2002 to 2010, we identified 106 patients with AS and coronary artery disease with at least one intermediate lesion treated according to FFR guidance. We matched 212 contemporary control patients with AS in which revascularization was decided on angiography only. More patients in the FFR-guided group underwent percutaneous coronary intervention (24% vs 13%; p = 0.019), whereas there was a trend toward less coronary artery bypass grafting (CABG) performed. After FFR, the number of diseased vessels was downgraded within the FFR-guided group (from 1.85 ± 0.97 to 1.48 ± 1; p <0.01) and compared with the angio-guided group (1.48 ± 1 vs 1.8 ± 0.97; p <0.01). Less aortic valve replacement was reported in the FFR-guided group (46% vs 57%; p = 0.056). In patients who underwent CABG, less venous conduits (0.5 ± 0.69 vs 0.73 ± 0.76; p = 0.05) and anastomoses (0.61 ± 0.85 vs 0.94 ± 1; p = 0.032) were necessary in the FFR-guided group. Up to 5 years, we found no difference in major adverse cardiac events (38% vs 39%; p = 0.98), overall death (32% vs 31%; p = 0.68), nonfatal myocardial infarction (2% vs 2%; p = 0.79), and revascularization (8% vs 7%; p = 0.76) between the 2 groups. In conclusion, FFR guidance impacts the management of selected patients with moderate or severe AS and coronary artery disease by resulting into deferral of aortic valve replacement, more patients treated with percutaneous coronary intervention, and in patients treated with CABG, into less venous grafts and anastomoses without increasing adverse event rates up to 5 years.
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Gioia
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Pellicano
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; University Heart Center Graz, Medical University Graz, Graz, Austria.
authors.forename: Gabor G
authors.initials: GG
authors.lastname: Toth
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Casselman
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Adjedj
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Van Praet
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Angela
authors.initials: A
authors.lastname: Ferrara
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: Stockman
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Ivan
authors.initials: I
authors.lastname: Degrieck
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Jozef
authors.initials: J
authors.lastname: Bartunek
authors.affiliation: Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. Electronic address: emanuele.barbato@olvz-aalst.be.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D016896:Treatment Outcome