This article is more than 5 years old. Information may no longer be current.
FFR-guided CABG linked to better outcomes than angiographic guidance
Click Here to Manage Email Alerts
At 6 years, fractional flow reserve-guided CABG resulted in a significant reduction in the rate of overall mortality or MI compared with angiography-guided CABG, according to results published in Circulation: Cardiovascular Interventions.
“Our findings indicate for the first time that a significant reduction in death or MI is associated with surgical myocardial revascularization guided by FFR as compared with traditional angiographic guidance,” Stephane Fournier, MD, from the department of cardiology at the Cardiovascular Center Aalst OLV Hospital in Belgium, and colleagues wrote. “Importantly, this clinical benefit does not come at the cost of excess in recurrent revascularization.”
To investigate the potential effect of FFR-guided CABG compared with angiography-guided CABG during long-term clinical follow-up, Fournier and colleagues retrospectively analyzed 627 patients treated with CABG between 2006 and 2010. Among the cohort, 198 patients had at least one stenosis grafted according to FFR, whereas 429 patients had all stenoses grafted according to angiography.
The coprimary endpoints were all-cause mortality/MI and MACE (all-cause mortality, MI and target vessel revascularization) up to 6-year follow-up.
In the FFR-guided group, patients were younger (66 years vs. 70 years; P < .001), were more commonly men (82% vs. 72%; P = .008) and were less likely to be diabetic (21% vs. 30%; P = .023).
Three hundred ninety-six patients were analyzed in a clinical follow-up after 1:1 propensity-score matching for age, sex and diabetes status.
The rate of all-cause mortality/MI was lower among patients in the FFR-guided group (16% vs. 25%; HR = 0.59; 95% CI, 0.38-0.93) compared with the angiography-guided group, whereas the rate of MACE was numerically lower in the FFR-guided group (21% vs. 26%; HR = 0.77; 95% CI, 0.51-1.16), according to the researchers.
In a related editorial, Cardiology Today’s Intervention Editorial Board Member Morton J. Kern, MD, MSCAI, and Arnold H. Seto, MD, MPA, both from the Veterans Administration Long Beach Health Care System, University of California, Irvine, wrote: “Critically important to accepting then changing CABG practice is the reality that interventional cardiologists must also accept it and help their surgical colleagues appreciate the value of ischemia-directed revascularization. New technologies such as FFR-computed tomography and angiographically derived FFR will likely make this task considerably easier than invasive pressure wire treatment. Will a CABG procedure needing fewer graft anastomoses associated with higher graft patency and reduced late death and MI move the approach from traditional complete angiographic revascularization to complete functional revascularization? Given the current data, it would seem that simpler will be better.” – by Dave Quaile
Disclosures: Fournier reports no relevant financial disclosures. Kern reports he is a consultant and speaker for Abbott/St. Jude Medical, Acist Medical, HeartFlow, Opsens, Philips/Volcano. Seto reports he is a speaker for Acist Medical and Philips/Volcano. Please see the study for all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts