BACKGROUND: Previous studies have shown that the use of fractional flow reserve (FFR) in addition to angiography significantly reduced the rate of all major adverse cardiovascular events (MACE). However, this practice has not been widely accepted and limited outcome data exist about FFR-guided percutaneous coronary intervention (PCI) in Taiwan. The aim of the present study was to evaluate the possible impact of FFR-guided PCI in coronary stenoses of intermediate severity. METHODS: We performed a retrospective case-control study on 443 cases of intermediate coronary stenoses in 206 patients recruited from our computerized database. The study patients were divided into two groups: the FFR group (n = 101) and the angiography group (n = 105), matched with age, gender, clinical and angiographic lesion characteristics. In the angiography group, the indicated lesions had been treated with PCI by angiographic or anatomical assessment, whereas those patients in the FFR group underwent PCI of indicated lesions only if the FFR was < 0.80. The primary end point was the MACE rate regarding death, nonfatal myocardial infarction (MI), and target vessel failure at a mean follow-up of 418 days. RESULTS: The MACE rate was similar in both groups (6% in the angiography group and 3% in the FFR group, p = 0.06). However, FFR-guided PCI strategy prevented unnecessary revascularization in up to 75% of patients, and markedly reduced costs of the index hospitalization. Moreover, multivariate analysis found that the use of drug-eluting stent and statin therapy, and the presence of family history of premature coronary artery disease and periprocedural MI are independent predictors of clinical outcomes. CONCLUSIONS: FFR-guided intervention, compared to angiography-guided intervention for Taiwanese patients with coronary stenoses of intermediate severity, achieved similar clinical outcomes and provided cost-savings.
BACKGROUND: Previous studies have shown that the use of fractional flow reserve (FFR) in addition to angiography significantly reduced the rate of all major adverse cardiovascular events (MACE). However, this practice has not been widely accepted and limited outcome data exist about FFR-guided percutaneous coronary intervention (PCI) in Taiwan. The aim of the present study was to evaluate the possible impact of FFR-guided PCI in coronary stenoses of intermediate severity. METHODS: We performed a retrospective case-control study on 443 cases of intermediate coronary stenoses in 206 patients recruited from our computerized database. The study patients were divided into two groups: the FFR group (n = 101) and the angiography group (n = 105), matched with age, gender, clinical and angiographic lesion characteristics. In the angiography group, the indicated lesions had been treated with PCI by angiographic or anatomical assessment, whereas those patients in the FFR group underwent PCI of indicated lesions only if the FFR was < 0.80. The primary end point was the MACE rate regarding death, nonfatal myocardial infarction (MI), and target vessel failure at a mean follow-up of 418 days. RESULTS: The MACE rate was similar in both groups (6% in the angiography group and 3% in the FFR group, p = 0.06). However, FFR-guided PCI strategy prevented unnecessary revascularization in up to 75% of patients, and markedly reduced costs of the index hospitalization. Moreover, multivariate analysis found that the use of drug-eluting stent and statin therapy, and the presence of family history of premature coronary artery disease and periprocedural MI are independent predictors of clinical outcomes. CONCLUSIONS: FFR-guided intervention, compared to angiography-guided intervention for Taiwanese patients with coronary stenoses of intermediate severity, achieved similar clinical outcomes and provided cost-savings.
Authors: Nico H J Pijls; William F Fearon; Pim A L Tonino; Uwe Siebert; Fumiaki Ikeno; Bernhard Bornschein; Marcel van't Veer; Volker Klauss; Ganesh Manoharan; Thomas Engstrøm; Keith G Oldroyd; Peter N Ver Lee; Philip A MacCarthy; Bernard De Bruyne Journal: J Am Coll Cardiol Date: 2010-05-28 Impact factor: 24.094
Authors: William F Fearon; Bernhard Bornschein; Pim A L Tonino; Raffaella M Gothe; Bernard De Bruyne; Nico H J Pijls; Uwe Siebert Journal: Circulation Date: 2010-11-29 Impact factor: 29.690
Authors: Shailja V Parikh; Michael Luna; Faith Selzer; Oscar C Marroquin; Suresh R Mulukutla; J Dawn Abbott; Elizabeth M Holper Journal: Catheter Cardiovasc Interv Date: 2013-10-24 Impact factor: 2.692
Authors: Pim A L Tonino; William F Fearon; Bernard De Bruyne; Keith G Oldroyd; Massoud A Leesar; Peter N Ver Lee; Philip A Maccarthy; Marcel Van't Veer; Nico H J Pijls Journal: J Am Coll Cardiol Date: 2010-06-22 Impact factor: 24.094
Authors: Jan-Willem E M Sels; Pim A L Tonino; Uwe Siebert; William F Fearon; Marcel Van't Veer; Bernard De Bruyne; Nico H J Pijls Journal: JACC Cardiovasc Interv Date: 2011-11 Impact factor: 11.195
Authors: G S Mintz; J J Popma; A D Pichard; K M Kent; L F Satler; Y C Chuang; C J Ditrano; M B Leon Journal: Circulation Date: 1995-04-01 Impact factor: 29.690