Deferral of coronary intervention on the basis of fractional flow reserve measurement: a real-world analysis

Background Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has been shown to be superior to angiography-guided PCI in randomized controlled studies. However, real-world data on the use and outcomes of FFR-guided PCI remain limited. Thus, we investigated the outcomes of patients undergoing FFR-guided PCI compared to angiography-guided PCI in a large, state-wide unselected cohort. Methods and results All patients undergoing PCI between June 2017 and June 2018 in New South Wales, Australia, were included. The cohort was stratified into the FFR-guided group when concomitant FFR was performed, and the angiography-guided group when no FFR was performed. The primary outcome was a combined endpoint of death or myocardial infarction (MI). Secondary outcomes included all-cause death, cardiovascular (CVS) death, and MI. The cohort comprised 10,304 patients, of which 542 (5%) underwent FFR-guided PCI. During a mean follow-up of 12±4 months, the FFR-guided PCI group had reduced occurrence of the primary outcome (hazard ratio [HR] 0.34, 95% confidence intervals [CI] 0.20–0.56, P<0.001), all-cause death (HR 0.18, 95% CI 0.07–0.47, P = 0.001), CVS death (HR 0.21, 95% CI 0.07–0.66, P = 0.01), and MI (HR 0.46, 95% CI 0.25–0.84, P = 0.01) compared to the angiography-guided PCI group. Multivariable Cox regression analysis showed FFR-guidance to be an independent predictor of the primary outcome (HR 0.45, 95% CI 0.27–0.75, P = 0.002), all-cause death (HR 0.22, 95% CI 0.08–0.59, P = 0.003), and CVS death (HR 0.27, 95% CI 0.09–0.83, P = 0.02). Conclusions In this real-world study of patients undergoing PCI, FFR-guidance was associated with lower rates of the primary outcome of death or MI, as well as the secondary outcomes of all-cause death and CVS death.

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AS-117 Long-Term Outcomes of Fractional Flow Reserve Guided Coronary Intervention in Consecutive ‘Real-World’ Patients

The American Journal of Cardiology ◽

10.1016/j.amjcard.2011.02.307 ◽

2011 ◽

Vol 107 (8) ◽

pp. 114A-115A

Author(s):

Michael Liang ◽

Damian Kelly ◽

Aniket Puri ◽

Suresh Perera ◽

Madhav Menon ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Real World ◽

Coronary Intervention ◽

Fractional Flow ◽

Long Term Outcomes ◽

Flow Reserve

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GW26-e0741 Fractional Flow Reserve Guided Percutaneous Coronary Intervention improves clinical outcome with reduced cost in Chinese real world practice

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.06.587 ◽

2015 ◽

Vol 66 (16) ◽

pp. C153

Author(s):

Po Hu ◽

Mengyao Tang ◽

Wenchao Song ◽

Jun Jiang ◽

Yong Su ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Clinical Outcome ◽

Fractional Flow Reserve ◽

Real World ◽

Coronary Intervention ◽

Fractional Flow ◽

Flow Reserve ◽

Percutaneous Coronary

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A real-world comparison of outcomes between fractional flow reserve-guided versus angiography-guided percutaneous coronary intervention

European Heart Journal ◽

10.1093/ehjci/ehaa946.1273 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Wong ◽

A Ng ◽

C Ada ◽

V Chow ◽

W Fearon ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Fractional Flow Reserve ◽

Primary Endpoint ◽

Real World ◽

Independent Predictor ◽

Coronary Intervention ◽

Funding Source ◽

Fractional Flow ◽

Flow Reserve ◽

Percutaneous Coronary

Abstract Background Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has been shown to be superior to angiography-guided PCI in randomized controlled studies. However, real-world data on the use and outcomes of FFR-guided PCI remain limited. Purpose To investigate the outcomes of patients undergoing FFR-guided PCI compared to angiography-guided PCI in a large, state-wide unselected cohort. Methods All patients undergoing PCI between June 2017 and June 2018 recorded by the Centre for Health Record Linkage (CHeReL) were included in the study. The CHeReL database is one of the largest data linkage systems in Australia, capturing health data from ≥97% of all healthcare facilities in the state of New South Wales, which has a population of 7.5 million people. The PCI cohort was stratified into the FFR-guided group when a concomitant FFR procedure was performed, and the angiography-guided group when no FFR was performed. The primary endpoint was a combined endpoint of death or myocardial infarction (MI). Secondary endpoints included all-cause death, cardiovascular (CV) death, and MI. Results The cohort comprised 10,304 patients, of which 542 (5%) underwent FFR-guided PCI. There were no significant differences in age, gender, or comorbidities between the two groups. During a mean follow-up of 12±4 months, the FFR-guided PCI group had reduced occurrence of the primary endpoint (3% vs 8%, P<0.001), all-cause death (1% vs 4%, P=0.001), CV death (1% vs 3%, P=0.01), and MI (2% vs 4%, P=0.01) (Figure). Multivariable Cox regression analysis demonstrated FFR-guidance to be an independent predictor of the primary endpoint (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.28–0.78, P=0.004), after adjusting for age, clinical presentation, comorbidities, and multi-vessel PCI. A sensitivity analysis was performed excluding patients that presented with acute MI, leading to a smaller cohort of 5,850 patients, of which 448 (8%) underwent FFR-guided PCI. FFR-guidance remained an independent predictor of the primary endpoint in this cohort of stable patients (HR 0.36, 95% CI 0.17–0.77, P=0.01). Conclusion In this real-world study of patients undergoing PCI, FFR-guidance was associated with improved clinical outcomes, driven by the lower hard endpoint of death or MI. The use of FFR-guided PCI remains limited worldwide, and efforts should be directed to increase adoption of this technique in future. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): National Heart Foundation of Australia Health Professional Scholarship

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Comparison of Resting Full-Cycle Ratio and Fractional Flow Reserve in a German Real-World Cohort

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.744181 ◽

2021 ◽

Vol 8 ◽

Author(s):

Hendrik Wienemann ◽

Annika Meyer ◽

Victor Mauri ◽

Till Baar ◽

Matti Adam ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Real World ◽

Predictive Value ◽

Gold Standard ◽

Morphological Characteristics ◽

Quantitative Coronary Angiography ◽

Coronary Intervention ◽

University Hospital ◽

Fractional Flow ◽

Flow Reserve

Objective: The aim of this study was to evaluate non-hyperemic resting pressure ratios (NHPRs), especially the novel “resting full-cycle ratio” (RFR; lowest pressure distal to the stenosis/aortic pressure during the entire cardiac cycle), compared to the gold standard fractional flow reserve (FFR) in a “real-world” setting.Methods: The study included patients undergoing coronary pressure wire studies at one German University Hospital. No patients were excluded based on any baseline or procedural characteristics, except for insufficient quality of traces. The diagnostic performance of four NHPRs vs. FFR ≤ 0.80 was tested. Morphological characteristics of stenoses were analyzed by quantitative coronary angiography.Results: 617 patients with 712 coronary lesions were included. RFR showed a significant correlation with FFR (r = 0.766, p < 0.01). Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of RFR were 78% (95% confidence interval = 75; 81), 72% (65; 78), 81% (77; 84), 63% (57; 69), and 86% (83; 89). Relevant predictors for discordance of RFR ≤ 0.89/FFR > 0.8 were LAD lesions, peripheral artery disease, age, female sex and non-focal stenoses. Predictors for discordance of RFR > 0.89/FFR ≤ 0.8 included non-LCX lesions, percent diameter stenosis and previous percutaneous coronary intervention in the target vessel. RFR and all other NHPRs were highly correlated with each other.Conclusion: All NHPRs have a similar correlation with the gold standard FFR and may facilitate the acceptance and implementation of physiological assessments of lesion severity. However, we found ~20% discordant results between NHPRs and FFR in our “all-comers” German cohort.

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Fractional Flow Reserve: Does a Cut-off Value add Value?

Interventional Cardiology Review ◽

10.15420/icr.2016.11.01.17 ◽

2016 ◽

Vol 11 (1) ◽

pp. 17

Author(s):

Shah R Mohdnazri ◽

◽

Thomas R Keeble ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Coronary Intervention ◽

Grey Zone ◽

Fractional Flow ◽

Non Invasive ◽

Invasive Test ◽

Flow Reserve ◽

A Value ◽

Percutaneous Coronary ◽

Value Add

Fractional flow reserve (FFR) has been shown to improve outcomes when used to guide percutaneous coronary intervention (PCI). There have been two proposed cut-off points for FFR. The first was derived by comparing FFR against a series of non-invasive tests, with a value of ≤0.75 shown to predict a positive ischaemia test. It was then shown in the DEFER study that a vessel FFR value of ≥0.75 was associated with safe deferral of PCI. During the validation phase, a ‘grey zone’ for FFR values of between 0.76 and 0.80 was demonstrated, where a positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI.

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