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Routine use of FFR associated with improved PCI outcomes
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Routine measurement of fractional flow reserve was linked to improved clinical outcomes and decreased use of stents in patients undergoing PCI, according to the results of a Korean study.
The rate of FFR use at the study site increased from 1.9% in January 2008 to 50.7% in December 2011 (P<.001) as a result of the introduction of mandated routine FFR use in Korea beginning in January 2010, according to the study findings. Seung-Jung Park, MD, with the Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, and colleagues compared practices and outcomes for PCI among patients at a Korean hospital before (n=2,699) and after (n=2,398) January 2010. The predominant alternative to FFR was angioplasty.
Patients who underwent PCI after routine FFR use had significantly lower rates of the primary endpoint (death, MI or repeat revascularization) at 1 year compared with those who underwent PCI before routine FFR use (4.8% vs. 8.6%; HR=0.55; 95% CI, 0.43-0.7). The researchers wrote that this was because of declines in periprocedural MI and repeat revascularization.
There was no difference in all-cause mortality at 1 year between the group undergoing PCI after routine FFR use and those undergoing PCI before routine FFR use (after, 1% vs. before, 1.1%; P=.89). However, the group undergoing PCI after routine FFR use had a lower adjusted rate of death or MI at 1 year (after, 3.3% vs. before, 5%; HR=0.66; 95% CI, 0.49-0.9). In addition, the group undergoing PCI after routine FFR use had a lower adjusted rate of repeat revascularization at 1 year (after, 1.8% vs. before, 3.7%; HR=0.49; 95% CI, 0.34-0.71).
Seung-Jung Park
In the propensity-score matched cohort of 2,178 pairs, the median number of lesions per patient was two (interquartile range [IQR], 1-2) for the group before routine FFR use vs. two (IQR, 1-2) for the group after routine FFR use (P=.68); however, the median number of stents implanted per patient was two (IQR, 1-3) for the group before vs. one (IQR, 1-2) after routine FFR use (P<.001).
Stent implantation was deferred in 475 patients; among them, only one noncardiac death and two repeat revascularizations occurred. Among 987 deferred lesions, 0.6% were revascularized at 1-year follow-up.
“Such favorable prognosis of deferred lesions may be related to the absolute lower rate of primary endpoints in our study,” Park, a Cardiology Today’s Intervention Editorial Board member, and researchers wrote.
The largest reductions in stent use occurred in the right coronary artery and the left circumflex artery, they reported.
“The stenosis-supplied smaller myocardial territories may have a higher chance to have a negative FFR, and subsequently a less chance to receive stent implantation,” Park and colleagues wrote.
Disclosure: The researchers report no relevant financial disclosures.
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