Real-world use of fractional flow reserve in Germany: results of the prospective ALKK coronary angiography and PCI registry.
BACKGROUND
There is growing evidence for beneficial prognostic and economic effects of FFR-guided treatment of stable coronary artery disease. We sought to evaluate the real-world use of FFR measurements in patients undergoing elective coronary angiography.


RESULTS
We analyzed the data of the prospective ALKK coronary angiography and PCI registry including data of 38 hospitals from January 2010 to December 2013. A total of 100,977 patients undergoing coronary angiography were included. In 3240 patients (3.2 %) intracoronary pressure measurement was performed. There was a wide range of use of FFR measurement in the different analyzed ALKK hospitals from 0.1 to 8.8 % in elective patients with suspected or known coronary artery disease (median 2.7 %, quartiles 0.9 and 5.3 %), with a successive increase of use over time during the study period. Overall, it was performed in 3.2 % of coronary angiographies. Use in patients with three-vessel disease (2.5 %) and recommendation for bypass surgery (1.6 %) was less frequent. In procedures without PCI, dose area product was higher in the FFR group (2641 cGy × cm2vs. 2368 cGy × cm2, p < 0.001), while it was lower in procedures with ad hoc PCI (4676 cGy × cm2vs. 5143 cGy × cm2, p < 0.001). The performing center turned out to be the strongest predictor.


CONCLUSIONS
The use of FFR measurement was very heterogeneous between different hospitals and in general relatively low, in particular in patients with multivessel disease or recommendation for bypass surgery, but there was a positive trend during the study period. Technically, FFR measurement was not associated with an increased periprocedural complication rate.
Klinik für Kardiologie, Klinikum Oldenburg gGmbH, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany. t.haerle@gmx.de.
Tobias
http://orcid.org/0000-0002-0492-7044
T
Härle
Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany.|Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
Uwe
U
Zeymer
Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
Matthias
M
Hochadel
Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany.
Ralf
R
Zahn
Klinik für Kardiologie, Herz- und Gefäß-Klinik GmbH, Bad Neustadt a. d., Haale, Germany.
Sebastian
S
Kerber
Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Landshut, Germany.
Bernhard
B
Zrenner
Klinikum Fulda, Medizinische Klinik I, Fulda, Germany.
Volker
V
Schächinger
Klinik für Kardiologie, Zentralklinik Bad Berka, Bad Berka, Germany.
Bernward
B
Lauer
Klinikum Wetzlar, Medizinische Klinik I, Wetzlar, Germany.
Thorsten
T
Runde
Klinik für Kardiologie, Klinikum Oldenburg gGmbH, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany.
Albrecht
A
Elsässer
D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000706:statistics & numerical data / Q000639:trends*; D062906:Cardiac Catheters; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D000069079:Radiation Exposure; D012042:Registries; D014160:Transducers, Pressure
Coronary artery bypass; Coronary artery disease; FFR; Fractional flow reserve; Percutaneous coronary intervention