Clinical InvestigationInterventional CardiologyLong-term clinical outcome after fractional flow reserve– versus angio-guided percutaneous coronary intervention in patients with intermediate stenosis of coronary artery bypass grafts
Section snippets
Patient population
All patients referred to coronary angiography for stable or unstable angina from January 2000 until June 2011 with at least 1 intermediate stenosis of an arterial or a venous bypass graft measured with FFR were included. Contemporary patients with previous CABG undergoing coronary angiography and with intermediate stenosis of an arterial or a venous bypass graft were used as a reference group. Intermediate stenosis was defined as percent diameter stenosis (%DS) at a visual estimation between
Clinical characteristics of the patients
A total of 223 patients were included: 65 in the FFR-guided group and 158 in the angio-guided group. No significant differences were found between the 2 groups in terms of clinical and demographic characteristics (Table I). In patients with unstable angina, all PCI procedures were performed within 48 hours from symptoms onset, similarly in the FFR-guided and angio-guided groups (27.5 ± 3.5 hours vs 28.1 ± 3.9 hours [P = .65], respectively).
Angiographic and procedural characteristics
Angiographic characteristics are reported in Table II.
Discussion
Our findings demonstrate that FFR-guided PCI of intermediate stenosis in bypass grafts is safe and results in a better clinical outcome as compared with an angio-guided PCI. This clinical benefit was more pronounced in arterial grafts, whereas it was limited to a reduced incidence of PMI in SVGs. In addition, a significant overall reduction in procedural costs has also been observed.
Conclusions
An FFR-guided revascularization strategy in CABGs is safe and results in better clinical outcomes as compared with an angio-guided strategy in arterial grafts. In SVGs, the FFR-guided strategy was associated with a significant reduction in PCI rate and procedural-related MI, with no excess risk up to 4-year clinical follow-up. This clinical benefit is achieved with a significant overall reduction in procedural costs.
Disclosures
None.
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