Sebastian Völz1, Christian Dworeck1, Björn Redfors1, Pétur Pétursson1, Oskar Angerås1, Li-Ming Gan2, Matthias Götberg3, Giovanna Sarno4, Dimitrios Venetsanos5, Per Grimfärd6, Robin Hofmann7, Jens Jensen8, Fredrik Björklund9, Mikael Danielewicz10, Rickard Linder11, Truls Råmunddal1, Ole Fröbert12, Nils Witt7, Stefan James4, David Erlinge3, Elmir Omerovic13. 1. Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden. 2. Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden; Early Clinical Development, Early CardioVascular, Renal and Metabolism, R&D BioPharmaceuticals, AstraZeneca, Gothenburg, Sweden. 3. Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden. 4. Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 5. Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden. 6. Department of Internal Medicine, Västmanlands Sjukhus, Västerås, Sweden. 7. Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden. 8. Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Unit of Cardiology, Capio St. Görans Sjukhus, Stockholm, Sweden. 9. Department of Cardiology, Östersund Hospital, Östersund, Sweden. 10. Department of Cardiology, PCI-Unit at Karlstad Hospital, Karlstad, Sweden. 11. Department of Cardiology, Danderyd Hospital, Stockholm, Sweden. 12. Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden. 13. Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden. Electronic address: elmir@wlab.gu.se.
Abstract
BACKGROUND: Intracoronary pressure wire measurement of fractional flow reserve (FFR) provides decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the effect of FFR on long-term clinical outcomes in patients with stable angina pectoris. OBJECTIVES: The purpose of this study was to determine the association between the usage of FFR and all-cause mortality in patients with stable angina undergoing PCI. METHODS: Data was used from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) on all patients undergoing PCI (with or without FFR guidance) for stable angina pectoris in Sweden between January 2005 and March 2016. The primary endpoint was all-cause mortality, and the secondary endpoints were stent thrombosis (ST) or restenosis and peri-procedural complications. The primary model was multilevel Cox proportional hazards regression adjusted with Kernel-based propensity score matching. RESULTS: In total, 23,860 patients underwent PCI for stable angina pectoris; of these, FFR guidance was used in 3,367. After a median follow-up of 4.7 years (range 0 to 11.2 years), the FFR group had lower adjusted risk estimates for all-cause mortality (hazard ratio: 0.81; 95% confidence interval [CI]: 0.73 to 0.89; p < 0.001), and ST and restenosis (hazard ratio: 0.74; 95% CI: 0.57 to 0.96; p = 0.022). The number of peri-procedural complications did not differ between the groups (adjusted odds ratio: 0.96; 95% CI: 0.77 to 1.19; p = 0.697). CONCLUSIONS: In this observational study, the use of FFR was associated with a lower risk of long-term mortality, ST, and restenosis in patients undergoing PCI for stable angina pectoris. This study supports the current European and American guidelines for the use of FFR during PCI and shows that intracoronary pressure wire guidance confers prognostic benefit in patients with stable angina pectoris.
BACKGROUND: Intracoronary pressure wire measurement of fractional flow reserve (FFR) provides decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the effect of FFR on long-term clinical outcomes in patients with stable angina pectoris. OBJECTIVES: The purpose of this study was to determine the association between the usage of FFR and all-cause mortality in patients with stable angina undergoing PCI. METHODS: Data was used from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) on all patients undergoing PCI (with or without FFR guidance) for stable angina pectoris in Sweden between January 2005 and March 2016. The primary endpoint was all-cause mortality, and the secondary endpoints were stent thrombosis (ST) or restenosis and peri-procedural complications. The primary model was multilevel Cox proportional hazards regression adjusted with Kernel-based propensity score matching. RESULTS: In total, 23,860 patients underwent PCI for stable angina pectoris; of these, FFR guidance was used in 3,367. After a median follow-up of 4.7 years (range 0 to 11.2 years), the FFR group had lower adjusted risk estimates for all-cause mortality (hazard ratio: 0.81; 95% confidence interval [CI]: 0.73 to 0.89; p < 0.001), and ST and restenosis (hazard ratio: 0.74; 95% CI: 0.57 to 0.96; p = 0.022). The number of peri-procedural complications did not differ between the groups (adjusted odds ratio: 0.96; 95% CI: 0.77 to 1.19; p = 0.697). CONCLUSIONS: In this observational study, the use of FFR was associated with a lower risk of long-term mortality, ST, and restenosis in patients undergoing PCI for stable angina pectoris. This study supports the current European and American guidelines for the use of FFR during PCI and shows that intracoronary pressure wire guidance confers prognostic benefit in patients with stable angina pectoris.
Authors: Aslihan Erbay; Lisa Penzel; Youssef S Abdelwahed; Jens Klotsche; Anne-Sophie Schatz; Julia Steiner; Arash Haghikia; Ulf Landmesser; Barbara E Stähli; David M Leistner Journal: Int J Cardiovasc Imaging Date: 2021-03-02 Impact factor: 2.357
Authors: Ana Gabaldon-Perez; Victor Marcos-Garces; Jose Gavara; Cesar Rios-Navarro; Gema Miñana; Antoni Bayes-Genis; Oliver Husser; Juan Sanchis; Julio Nunez; Francisco Javier Chorro; Vicente Bodi Journal: J Clin Med Date: 2021-02-05 Impact factor: 4.241
Authors: Christopher C Y Wong; Austin C C Ng; Cuneyt Ada; Vincent Chow; William F Fearon; Martin K C Ng; Leonard Kritharides; Andy S C Yong Journal: PLoS One Date: 2021-12-16 Impact factor: 3.240