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Knowing FFR reduced physicians’ variability in treatment decisions
A simulated decision exercise showed that cardiologists learning the myocardial fractional flow reserve measurement reduced diagnostic variability among physicians and changed their treatment decisions for patients with non-STEMI.
Researchers enrolled 100 consecutive patients to investigate whether knowing the myocardial FFR compared with coronary angiography alone improved diagnostic efficiency in patients with non-STEMI. Five interventional cardiologists retrospectively and independently reviewed the medical history and coronary angiogram to derive a treatment decision. After next seeing FFR results, the cardiologists reviewed their initial treatment decisions.
The proportion of patients allocated to each treatment option initially differed among the cardiologists (P=.0061).
After FFR disclosure, the number of patients in whom the treatment decisions made by each cardiologist independently conformed (and so represented three or more of the five cardiologists) increased from 65% to 91% (P=.0094).
In addition, the cardiologists changed their initial treatment plans in 46% of patients (P=.0016). Physicians changed their decisions to medical therapy in 24% of patients (P=.0016), which was associated with reductions in deferred management (P=.0067), single-vessel PCI (P=.0052) and multivessel PCI (P=.046).
FFR measurement is performed in less than 1% of all cases, researchers noted, yet treatment decisions based on FFR measurement in patients with non-STEMIs are associated with a better prognosis.
“Ultimately, treatment strategies are defined by randomized trials with relevant clinical endpoints, and the Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes (FAMOUS-NSTEMI) multicenter trial is designed to prospectively test the diagnostic and clinical utility of FFR-guided treatment decisions in routine practice,” they wrote.
Disclosure: The researchers report no relevant financial disclosures.