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Thirty-month outcome after fractional flow reserve-guided versus conventional multivessel percutaneous coronary
Nattawut Wongpraparut1, Vankata Yalamanchili, Venkat Pasnoori
1Division of Cardiology, University of Louisville, Louisville, Kentucky, USA.
Insights
Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in multivessel disease (MVD) patients reduces treated vessels, costs, and adverse events compared to conventional PCI. FFR-PCI improves event-free survival significantly.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Multivessel disease (MVD) is common in coronary artery disease.
- Conventional percutaneous coronary intervention (PCI) relies on visual stenosis assessment.
- The efficacy of FFR-guided PCI in MVD patients was previously unknown.
Purpose of the Study:
- To compare FFR-guided PCI with conventional PCI in patients with MVD.
- To evaluate procedural outcomes, event rates, and costs.
Main Methods:
- Prospective enrollment of 137 MVD patients (312 vessels).
- FFR assessment of all vessels; PCI performed if FFR < 0.75.
- Conventional PCI group underwent multivessel PCI based on visual estimation.
Main Results:
- FFR-PCI group: 1.12 vessels treated vs. 2.27 in conventional PCI group (p < 0.001).
- FFR-PCI group: Lower procedure cost ($2,572 vs. $3,167, p < 0.001).
- 30-month event-free survival: 89% for FFR-PCI vs. 59% for conventional PCI (p < 0.01).
Conclusions:
- FFR-guided PCI is superior to conventional PCI in MVD patients.
- FFR-PCI reduces the number of treated vessels, procedure costs, and adverse events.
- FFR-guided PCI significantly improves long-term event-free survival in MVD patients.
Abstract:
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 >or=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 dollars +/- 1,194 dollars vs 2,572 dollars +/- 934 dollars, 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.
