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Influence of routine assessment of fractional flow reserve on decision making during coronary interventions
Fernando M Sant'Anna1, Expedito E R Silva, Leonardo Alves Batista
1Santa Helena Heart Hospital, Cabo Frio, Brazil. fernandomendes@cardiol.br
Insights
Fractional flow reserve (FFR) measurements significantly alter treatment decisions for complex coronary artery disease. Using FFR instead of angiography alone changed planned stenting in 32% of lesions and 48% of patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Physiology
Background:
- Determining ischemia-causing lesions in complex coronary artery disease is challenging.
- Angiography alone is often subjectively interpreted for stenting decisions.
- Fractional flow reserve (FFR) offers objective ischemia assessment.
Purpose of the Study:
- To evaluate changes in percutaneous intervention (PCI) strategy based on FFR versus angiography.
- To assess the impact of physiologic measurements on stenting decisions.
Main Methods:
- 250 patients undergoing elective PCI were included.
- Stenoses >=50% by angiography were assessed by FFR.
- Stenting was performed if FFR <0.75; otherwise, no intervention was done.
Main Results:
- FFR measurements were obtained in 96% of lesions.
- Angiographic assessment was followed in 68% of stenoses.
- FFR led to a strategy change in 32% of stenoses and 48% of patients.
Conclusions:
- Physiologic assessment with FFR significantly refines decision-making in PCI.
- Relying solely on angiography can lead to suboptimal treatment choices.
- FFR improves the accuracy of lesion selection for stenting.
Abstract:
In complex coronary artery disease, it is sometimes difficult to determine which lesions are associated with reversible ischemia and should be stented. Fractional flow reserve (FFR) is an established objective methodology to indicate which lesions produce ischemia. Despite this, the selection of lesions to be stented is often based on the subjectively interpreted angiogram alone. The aim of this study in patients admitted for elective percutaneous intervention (PCI) was to evaluate the change in strategy if the decision to intervene was based on FFR measurement rather than on angiographic assessment. Two hundred fifty consecutive patients (471 arteries) scheduled for PCI were included in this study. All stenoses >or=50% by visual estimation and initially selected to be stented by 3 independent reviewers were assessed by FFR measurements. If FFR was <0.75, stenting was performed; if FFR was >or=0.75, no interventional treatment was given. Optimal pressure measurements were obtained in 452 lesions (96%). Diameter stenosis was 62 +/- 12%, and FFR was 0.67 +/- 0.17 for the entire group. In 68% of the stenoses, initial strategy as assessed from the angiogram was followed, and in 32%, there was a change in the planned approach based on FFR. In 48% of the patients, there was >or=1 lesion in which the treatment decision was changed after physiologic measurements. In conclusion, in this prospective, nonselective, but complete study representing the real world of PCI, 32% of the coronary stenoses and 48% of patients would have received a different treatment if the decision had been based on angiography only, stressing the utility of physiologic assessment in refining decision making during PCI.
