R3F: Coronary Revascularization Strategy Reclassification With FFR at Time of Diagnostic Angiography

Fractional flow reserve (FFR) can be used to safely guide clinical decision-making in coronary revascularization. About half of patients in whom FFR is assessed after referral for coronary angiography will have a different revascularization than projected, but the change in treatment does not affect patient safety, according to results of the R3F Registry Trial, presented Nov. 19 as part of AHA 2013, and published simultaneously in Circulation.

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Investigators laid out a revascularization strategy for 1,075 consecutive patients based on the results of diagnostic angiography at 20 centers in France. The "a priori" strategy included medical therapy for 55 percent, percutaneous coronary intervention (PCI) for 38 percent and coronary artery bypass graft surgery (CABG) for 7 percent. Based on FFR findings, 43 percent of patients were reclassified from one revascularization strategy to another. Final treatment included medical therapy for 58 percent of patients, PCI for 32 percent and CABG for 10 percent.

There was no difference in survival free of MACE at one year between patients classified or not reclassified. Angina status was somewhat improved at one month and six months for reclassified patients and numerically better at one year, but there was no statistically significant difference in angina status between the two groups at one year.

Recent data suggest that FFR can be useful in guiding coronary revascularization in PCI patients, but there were no data on the potential impact of FFR assessment on patients referred for coronary angiography. The authors note that their trial appears to be the first large study of FFR in revascularization decision-making for patients referred for diagnostic angiography.

"This study demonstrates that it is safe to pursue a revascularization strategy divergent to that suggested by angiography alone but guided by FFR measurements," said lead author Eric Van Belle, MD, PhD, FACC, Hôpital Cardiologique, Lille, France. "The present data further support the concept of physiologically guided coronary revascularization and provide an important basis for future studies."

Keywords: Registries, Coronary Angiography, Referral and Consultation, Patient Safety, Coronary Artery Bypass, Percutaneous Coronary Intervention

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