RIPCORD 2: No Benefit of Systematic FFR vs. Angiography During Diagnostic Angiography

Adding systematic fractional flow reserve (FFR) assessment to coronary angiography did not reduce costs, improve quality of life or reduce major adverse cardiac events or revascularization rates vs. angiography alone in patients undergoing diagnostic coronary angiography for stable angina or non-STEMI, according to results of the RIPCORD 2 trial presented during ESC Congress 2021.

The open label, randomized, controlled trial enrolled 1,100 patients from 17 centers in the UK. The mean age was 64 years and 75% were men. All participants had a stenosis of 30% or greater in at least one coronary artery suitable for either PCI or CABG. Patients were randomized to systematic pressure wire-derived FFR after angiography or angiography alone.

The primary outcomes were total hospital cost, quality of life and angina status after one year. Results showed that the median total hospital cost over the one-year period was similar in the two groups. There were no differences between groups in inpatient and outpatient costs, nights in hospital or the number of outpatient visits. In addition, there were no differences between groups in quality of life and angina status at one year.

Regarding secondary endpoints, there were a similar number of deaths, strokes, myocardial infarctions, and unplanned revascularizations in both groups. Further, there were not "significant differences" between the groups in their management plans. However, in the FFR group, the strategy was chosen immediately after the catheter laboratory procedure in more than 98% of patients whereas a further test was required in 14.7% of patients in the angiography alone group.

"RIPCORD 2 found that a strategy of systematic FFR in all major coronary arteries amenable to revascularization was cost neutral compared to angiography-guided management and was not associated with any difference in quality of life or angina status at one year," said Nicholas Curzen, BM(Hons), PhD, the primary investigator. "In addition, there was no change in the management plan or the rate of clinical events, indicating that this strategy provides no overall advantage compared to angiography alone."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ESC Congress, ESC21, Coronary Angiography, Chest Pain, Coronary Artery Disease, Percutaneous Coronary Intervention, ACC International

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