A retrospective, registry-based study comparing long-term outcomes of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurements vs. angiography-guided PCI supports the use of FFR measurements to guide the performance of PCI in routine clinical practice.

The study, published on Jan. 23 in the European Heart Journal, used 7,358 patients referred for PCI at the Mayo Clinic in Rochester, Minn., between 2002 and 2009, who were divided into groups of patients who were to undergo PCI with or without having received FFR measurements. The group that did receive FFR measurements prior to PCI were further divided into those who received PCI based on the measurements and those who had PCI deferred in at least one target vessel based on the measurements.

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Results showed that initially, patients who underwent interventions guided by FFR measurements were found to have had a non-significant lower rate of death or MI compared with those who received PCI guided only by angiography [HR: 0.85, 95 percent CI: 0.71–1.01, P=0.06]. However, patients who had PCI deferred based on FFR measurements were found to have had a reduced rate of myocardial infarction (HR: 0.46, 95 percent CI: 0.26–0.82, P=0.008).

In addition, after the study's investigators excluded patients who had FFR measurements between .75 and .80 and had PCI deferred in at least one vessel, they found that the use of FFR measurements was associated with a significantly reduced rate of death or MI (HR: 0.80, 95 percent CI: 0.66–0.96, P=0.02). These patients were excluded because a previous study had demonstrated that deferring PCI in lesions with an FFR measurement of less than .80 was harmful to the patient.

The authors concluded that patients who underwent FFR measurements tended to have lower rates of death or MI (p=0.06) and more favorable long-term outcomes. Additionally, favorable long-term outcomes in the FFR-guided group is "in keeping with previous clinical trials, and therefore provides important evidence supporting the rationale for the use of FFR in routine practice," the authors said.

Keywords: Registries, Myocardial Infarction, Cardiovascular Diseases, Percutaneous Coronary Intervention

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