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RIPCORD: Routine FFR measurement at coronary angiography influenced treatment plan
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After an initial assessment using only coronary angiography, the treatment plan for more than 25% of patients with chest pain changed after measuring fractional flow reserve, results from the RIPCORD trial concluded.
The study was initially presented at EuroPCR in 2013 and was published recently in Circulation: Cardiovascular Interventions.
Investigators from several sites in the United Kingdom conducted the RIPCORD trial and noted in the study that there are flaws in the use of coronary angiography for diagnosing and managing chest pain. They added that FFR has been documented as an effective strategy for describing lesion-level ischemia and improving outcomes in PCI. However, the research community has yet to determine how routine FFR at diagnostic coronary angiography affects patient management.
The analysis included 200 patients with chest pain. All patients underwent coronary angiography for clinical indications.
Based on the results of the coronary angiography, the supervising cardiologist created a management plan for each patient. Patients were designated as being candidates for optimal medical therapy (OMT) alone, PCI, CABG or requiring more information. The supervising cardiologist also recorded significant stenoses.
An interventional cardiologist then assessed FFR in all patients with stentable arteries, which were defined as those ≥2.25 mm. Once the FFR results were made available, the supervising clinician made a second management plan.
After the FFR information was disclosed, the initial management plan based on coronary angiography results changed in 26% of the cohort. Changes in the number and localization of functional stenoses were changed in 32% of patients.
Among 72 patients that were designated for OMT after coronary angiography results were reported, 13% were referred for revascularization when FFR data were made available.
There were 89 patients recommended for OMT based on FFR. Of this group, 28% would have been recommended for revascularization using coronary angiography alone.
“Routine measurement of FFR at [coronary angiography] has important influence both on which coronary arteries have significant stenoses and on patient management,” the researchers concluded, adding that the findings could have important implications for clinical practice.
Disclosure: The researchers report financial disclosures with Abbott Vascular, Boston Scientific, Daiichi Sankyo, Haemonetics, Medtronic and St. Jude Medical.
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