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Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation

Jamie Layland1, Keith G Oldroyd2, Nick Curzen3

  • 1West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.

European Heart Journal
|September 3, 2014
PubMed

Insights

Fractional flow reserve (FFR)-guided management in non-ST segment elevation myocardial infarction (NSTEMI) patients led to less revascularization than standard angiography guidance. Further trials are needed to confirm health outcomes and cost-effectiveness.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Non-ST segment elevation myocardial infarction (NSTEMI) management involves complex decisions regarding revascularization.
  • Fractional flow reserve (FFR) is a physiological measure used to assess the hemodynamic significance of coronary stenoses.
  • Current guidelines recommend FFR for guiding revascularization in select cases.

Purpose of the Study:

  • To compare the management and outcomes of NSTEMI patients managed with FFR-guided therapy versus standard angiography-guided care.
  • To determine if FFR disclosure influences treatment decisions and subsequent revascularization rates.
  • To evaluate the impact of FFR-guided management on patient health outcomes and quality of life.

Main Methods:

  • A prospective, multicenter, randomized controlled trial involving 350 NSTEMI patients.
  • Patients were randomly assigned (1:1) to either FFR-guided management (FFR disclosed) or angiography-guided standard care (FFR measured but not disclosed).
  • Revascularization was indicated if FFR ≤0.80, using percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG).

Main Results:

  • The FFR-guided group had a higher proportion of patients initially treated with medical therapy (22.7% vs. 13.2%, P=0.022).
  • FFR disclosure altered treatment plans in 21.6% of patients.
  • At 12 months, revascularization rates were lower in the FFR-guided group (79.0% vs. 86.8%, P=0.054).
  • No significant differences in health outcomes or quality of life were observed between the groups.

Conclusions:

  • Angiography-guided management in NSTEMI patients was associated with higher rates of coronary revascularization compared to FFR-guided management.
  • FFR-guided management may reduce revascularization rates without compromising short-term health outcomes.
  • A larger trial is warranted to definitively assess health outcomes and cost-effectiveness.
Abstract

Keywords:
Acute coronary syndromeCoronary revascularizationFractional flow reserveMedical therapyNon-ST elevation myocardial infarction

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