Trends in the Outcomes of Percutaneous Coronary Intervention With the Routine Incorporation of Fractional Flow Reserve in Real Practice
What is the impact of the routine use of fractional flow reserve (FFR) on the practice and outcomes of percutaneous coronary intervention (PCI)?
The use of FFR at an academic Korean center increased from 1.9% to 50.7% between January 2008 and December 2011. A total of 5,097 patients (2,699 patients before and 2,398 after the routine use of FFR) underwent PCI. Propensity score (PS) matching was used to compare the rates of the primary endpoint (death, myocardial infarction [MI], or repeat revascularization) at 1 year of the cohort before and after the routine use of FFR.
Stent implantation was deferred in 475 patients with use of FFR. In the PS-matched cohort (2,178 pairs), the median number of lesions per patient was two (interquartile range [IQR] 1-2) before versus two (IQR 1-2) after the routine FFR use (p = 0.68); the median number of stents implanted per patient was two (IQR 1-3) versus one (IQR 1-2), respectively (p < 0.001). The rate of the primary endpoint at 1 year was significantly lower in patients after the routine FFR use (hazard ratio, 0.55; 95% confidence interval, 0.43-0.70; p < 0.001). This was primarily due to a reduction in periprocedural MI and repeat revascularization with no difference in mortality.
The authors concluded that routine measurement of FFR in daily practice is associated with less use of stents and an improvement in clinical outcomes.
This study adds to the growing evidence supporting use of FFR guidance for PCI of intermediate lesions. The use of FFR was associated with less stenting and better clinical outcomes, thus supporting FFR for routine PCI guidance in stable CAD. 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: Invasive Cardiovascular Angiography and Intervention
Keywords: Myocardial Infarction, Octamer Transcription Factor-1, Propensity Score, Cardiovascular Diseases, Parkinson Disease, Confidence Intervals, Stents, Percutaneous Coronary Intervention
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