Outcome Impact of Coronary Revascularization Strategy Reclassification With Fractional Flow Reserve at Time of Diagnostic Angiography: Insights From a Large French Multicenter Fractional Flow Reserve Registry

Study Questions:

How does routine use of fractional flow reserve (FFR) impact revascularization decisions in patients undergoing coronary angiography?

Methods:

The authors reported the results of a French registry that investigated 1,075 consecutive patients undergoing diagnostic angiography at 20 hospitals. Investigators were asked to define prospectively their revascularization strategy a priori based on angiography before performing the FFR. The final revascularization strategy, reclassification of the strategy by FFR and 1-year clinical follow-up, were prospectively recorded.

Results:

The a priori strategy based on angiography was medical therapy in 55% and revascularization in 45% (percutaneous coronary intervention [PCI] 38% and coronary artery bypass grafting [CABG] 7%). Nearly all (95.7%) patients were treated according to FFR. The applied strategy after FFR was medical therapy in 58% and revascularization in 42% (PCI, 32%; CABG, 10%). The final strategy applied differed from the a priori plan in 43% of cases. Reclassification was observed in 33% of a priori medical patients, in 56% of a priori PCI patients, and in 62% of a priori CABG patients. There was no difference in the 1-year outcome of patients whose treatment was reclassified compared with those in whom the FFR and angiography-based treatment plans were concordant.

Conclusions:

The authors concluded that performing FFR during diagnostic angiography is associated with a change in revascularization decision in about one-half of the patients.

Perspective:

This study adds to the growing evidence supporting use of FFR guidance for PCI of intermediate lesions. Routine FFR assessment was associated with a change in treatment plan for at least 40% of the patients in this study. The use of FFR has been associated with less stenting and better clinical outcomes in other studies. Currently, only a small proportion of patients in the United States undergo FFR-guided PCI, and quality efforts are needed to increase uptake of this useful technology.

Clinical Topics: Anticoagulation Management, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Aortic Surgery, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Coronary Stenosis, Coronary Angiography, Cardiology, Coronary Circulation, Coronary Artery Bypass, Angioplasty, Balloon, Coronary, Hirudins, United States, Stents, Percutaneous Coronary Intervention


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