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Published on: November 24, 2014
Fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery
Gabor Toth1, Bernard De Bruyne, Filip Casselman
1Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
Insights
Fractional flow reserve (FFR)-guided coronary artery bypass graft surgery reduced graft anastomoses and on-pump procedures without increasing adverse events. This approach also led to less angina in patients with coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Fractional flow reserve (FFR) is established for percutaneous coronary intervention but understudied in coronary artery bypass graft (CABG) surgery candidates.
- Understanding FFR's role in CABG is crucial for optimizing surgical decisions.
Purpose of the Study:
- To evaluate the impact of FFR-guided versus angiography-guided CABG on clinical outcomes.
- To assess the safety and efficacy of FFR in guiding CABG procedures.
Main Methods:
- Retrospective registry analysis of 627 CABG patients with intermediate coronary stenosis (2006-2010).
- Comparison between angiography-guided (n=429) and FFR-guided (n=198) groups.
- Primary endpoint: major adverse cardiovascular events (MACE) at 3 years (death, MI, TVR).
Main Results:
- FFR-guided CABG resulted in fewer anastomoses and lower on-pump surgery rates.
- No significant difference in 3-year MACE between angiography-guided and FFR-guided groups (12% vs. 11%).
- FFR-guided CABG showed a significantly lower rate of angina (31% vs. 47%).
Conclusions:
- FFR-guided CABG is associated with fewer grafts and less on-pump surgery.
- This strategy does not increase adverse cardiovascular events at 3 years.
- FFR guidance in CABG improves angina symptoms compared to angiography alone.
Background:
Fractional flow reserve (FFR) is well established for patients undergoing percutaneous coronary intervention, yet little is known about candidates for coronary artery bypass graft surgery.
Methods And Results:
From 2006 to 2010, we retrospectively included in this registry 627 consecutive patients treated by coronary artery bypass graft surgery having at least 1 angiographically intermediate stenosis. In 429 patients, coronary artery bypass graft surgery was based solely on angiography (angiography-guided group). In 198 patients, at least 1 intermediate stenosis was grafted with an FFR ≤0.80 or deferred with an FFR >0.80 (FFR-guided group). The end point was major adverse cardiovascular events at 3 years, defined as the composite of overall death, myocardial infarction, and target vessel revascularization. The rate of angiographic multivessel disease was similar in the angiography-guided and FFR-guided groups (404 [94.2%] versus 186 [93.9%]; P=0.722). In the FFR-guided group, this was significantly downgraded after FFR measurements to 86.4% (P<0.001 versus before FFR) and was associated with a smaller number of anastomoses (3 [2-3] versus 3 [2-4]; P<0.001) and rate of on-pump surgery (49% versus 69%; P<0.001). At 3 years, major adverse cardiovascular events were not different between the angiography-guided and FFR-guided groups (12% versus 11%; hazard ratio, 1.030; 95% confidence interval, 0.627-1.692; P=0.908). However, the FFR-guided group compared with the angiography-guided group presented a significantly lower rate of angina (Canadian Cardiovascular Society class II-IV, 31% versus 47%; P<0.001).
Conclusions:
FFR-guided coronary artery bypass graft surgery was associated with a lower number of graft anastomoses and a lower rate of on-pump surgery compared with angiography-guided coronary artery bypass graft surgery. This did not result in a higher event rate during up to 36 months of follow-up and was associated with a lower rate of angina.
