Coronary artery disease
Thirty-Month Outcome After Fractional Flow Reserve–Guided Versus Conventional Multivessel Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2005.05.040Get rights and content

We investigated the value of fractional flow reserve (FFR)–guided percutaneous coronary intervention (FFR-PCI) versus conventional PCI in patients with multivessel disease (MVD). Conventional PCI is performed by visual estimation of the stenosis. Deferral of PCI because of a FFR ≥0.75 is associated with low event rates. However, the value of FFR-PCI in patients with MVD is unknown. We prospectively enrolled 137 patients (312 vessels) with MVD to compare FFR-PCI and conventional PCI. In the FFR-PCI group, FFR of all vessels was performed, and PCI of stenoses with a FFR <0.75 was performed. In the conventional PCI group, patients underwent multivessel PCI by visual estimation of the stenoses. Procedural characteristics, event rates, and cost were compared between the 2 groups. In the FFR-PCI group, after FFR analysis in 57 patients (128 vessels), PCI was performed in 48 patients (53 vessels). In the conventional PCI group, 80 patients (184 vessels) underwent PCI. The average number of vessels per patient that underwent PCI and the cost of procedure were significantly greater in the conventional PCI group than in the FFR-PCI group (2.27 ± 0.50 vs 1.12 ± 0.30 vessels and $3,167 ± $1,194 vs $2,572 ± $934, respectively; p <0.001). The 30-month Kaplan-Meier event-free survival estimate was significantly higher in the FFR-PCI group than in the conventional PCI group (89% vs 59%, p <0.01). In conclusion, the results of the present study have demonstrated that in patients with MVD, compared with conventional PCI, FFR-PCI significantly reduces the number of vessels undergoing PCI, the event rate, and the cost of the procedure.

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Study patients and lesions

From October 2000 to August 2002, 137 consecutive patients (312 vessels) were prospectively assigned to either FFR-PCI (57 patients, 128 vessels) or conventional PCI (80 patients, 184 vessels). The choice between FFR-guided PCI and conventional PCI was left to the discretion of the operators and was primarily dictated by patient preference and the prevailing number of patients enrolled in each group to even out the number of patients. Patients were included in this study if they had stable

Clinical characteristics

The clinical features of the 2 groups are listed in Table 1. FFR and PCI were successfully performed in all patients. The 2 groups were matched with respect to clinical characteristics, including age, gender, and major cardiovascular risk factors (Table 1).

Procedural and angiographic characteristics

The procedural and angiographic characteristics of the 2 groups are listed in Table 2. Angiographic and procedural success was achieved in 98.3% versus 97.5% and 87% versus 76% in the FFR-PCI and conventional PCI groups, respectively (p = NS;

Discussion

The results of this study have demonstrated that among patients with MVD, a decision-making strategy based on a FFR of <0.75 to perform PCI is associated with a 30-month event-free survival estimate of 89%, significantly higher than that resulting from a strategy based on the visual estimation of the stenosis. Furthermore, using a strategy such as FFR-guided PCI avoids unnecessary resource utilization and thereby significantly reduces the cost of the procedure. In line with this, our results

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