Editorial commentFunctional assessment of bypass grafts by fractional flow reserve

Pijls, Nico H.J.; Botman, Kees Joost

doi:10.1016/j.ejcts.2006.12.022

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…Patients with ST-elevation myocardial infarction (MI), multivessel FFR, or PCI that was performed in a non-FFR artery were also excluded because of the inability to distinguish clinical outcomes related to the vessel that was assessed by FFR. Prior coronary artery bypass grafting (CABG) was also excluded because FFR measurements may be confounded by native artery patency . Implausible FFR values (<0.30 and ≥1.00) were also excluded .…”

Section: Methodsmentioning

confidence: 99%

Association Between Adherence to Fractional Flow Reserve Treatment Thresholds and Major Adverse Cardiac Events in Patients With Coronary Artery Disease

Sud

Han

Koh

et al. 2020

JAMA

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IMPORTANCE Fractional flow reserve (FFR) is an invasive measurement used to assess the potential of a coronary stenosis to induce myocardial ischemia and guide decisions for percutaneous coronary intervention (PCI). It is not known whether established FFR thresholds for PCI are adhered to in routine interventional practice and whether adherence to these thresholds is associated with better clinical outcomes.OBJECTIVE To assess the adherence to evidence-based FFR thresholds for PCI and its association with clinical outcomes. DESIGN, SETTING, AND PARTICIPANTSA retrospective, multicenter, population-based cohort study of adults with coronary artery disease undergoing single-vessel FFR assessment (excluding ST-segment elevation myocardial infarction) from April 1, 2013, to March 31, 2018, in Ontario, Canada, and followed up until March 31, 2019, was conducted. Two separate cohorts were created based on FFR thresholds (Յ0.80 as ischemic and >0.80 as nonischemic). Inverse probability of treatment weighting was used to account for treatment selection bias.EXPOSURES PCI vs no PCI. MAIN OUTCOMES AND MEASURESThe primary outcome was major adverse cardiac events (MACE) defined by death, myocardial infarction, unstable angina, or urgent coronary revascularization.RESULTS There were 9106 patients (mean [SD] age, 65 [10.6] years; 35.3% female) who underwent single-vessel FFR measurement. Among 2693 patients with an ischemic FFR, 75.3% received PCI and 24.7% were treated only with medical therapy. In the ischemic FFR cohort, PCI was associated with a significantly lower rate and hazard of MACE at 5 years compared with no PCI (31.5% vs 39.1%; hazard ratio, 0.77 [95% CI, 0.63-0.94]). Among 6413 patients with a nonischemic FFR, 12.6% received PCI and 87.4% were treated with medical therapy only. PCI was associated with a significantly higher rate and hazard of MACE at 5 years compared with no PCI (33.3% vs 24.4%; HR, 1.37 [95% CI, 1.14-1.65]) in this cohort.CONCLUSIONS AND RELEVANCE Among patients with coronary artery disease who underwent single-vessel FFR measurement in routine clinical practice, performing PCI, compared with not performing PCI, was significantly associated with a lower rate of MACE for ischemic lesions and a higher rate of MACE for nonischemic lesions. These findings support the performance of PCI procedures according to evidence-based FFR thresholds.

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Section: Methodsmentioning

confidence: 99%

Association Between Adherence to Fractional Flow Reserve Treatment Thresholds and Major Adverse Cardiac Events in Patients With Coronary Artery Disease

Sud

Han

Koh

et al. 2020

JAMA

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“…Pressure wire derived FFR is a widely accepted and extensively studied diagnostic modality to assess the physiological significance of epicardial coronary stenosis. This method is less well validated in bypass grafts but specificity and negative predictive value are comparable to stress MPI . Therefore, FFR is believed to be as clinically useful and lesion specific in grafts as it is in native coronary arteries and the same cut off (0.75–0.80) for physiological significance is recommended.…”

Section: Discussionmentioning

confidence: 99%

Transient right internal thoracic arterial graft kink related to respiratory movements: Documentation of its existence, relevance and proposed management

Pankert

L’Allier

Tardif

2013

Cathet Cardio Intervent

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In this case report, we provide the first detailed description of an intermittent mechanical kink of a right internal thoracic artery (ITA) graft to the left anterior descending coronary artery secondary to respiratory movements, and its assessment by pressure wire derived fractional flow reserve (FFR). The patient presented with recurrent unstable angina and documented anterior/anterolateral ischemia. Persistent symptoms were attributed to the ITA kink and stenting was planned on clinical grounds. However, the lesion proved not physiologically significant when FFR was assessed after intermittency related to respiratory movements was documented. Complex stenting was therefore avoided and medical therapy was prescribed for distal diagonal disease. We therefore propose that intermittency should be actively investigated when a kink is documented in a coronary bypass graft by conventional angiography (using dedicated angiographic evaluation in maximal inspiration and expiration). Furthermore, when this type of lesion is encountered, we suggest that it should be assessed physiologically using pressure wire derived FFR before potentially complex interventions are considered.

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“…With FFR <0.75, further revascularisation is needed, preferably on the native vessel. With FFR >0.80, no invasive treatment is needed 26,27 . Image-based computational functional models have not been fully validated in CABG patients.…”

Section: Cabgmentioning

confidence: 99%

Coronary physiology in the catheterisation laboratory: an A to Z practical guide

Fezzi¹,

Huang²,

Lunardi³

et al. 2022

AsiaIntervention

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Coronary revascularisation, either percutaneous or surgical, aims to improve coronary flow and relieve myocardial ischaemia. The decision-making process in patients with coronary artery disease (CAD) remains largely based on invasive coronary angiography (ICA), even though until recently ICA could not assess the functional significance of coronary artery stenoses. Invasive wire-based approaches for physiological evaluations were developed to properly assess the ischaemic relevance of epicardial CAD. Fractional flow reserve (FFR) and later, instantaneous wave-free ratio (iFR), were shown to improve clinical outcomes in several patient subsets when used for coronary revascularisation guidance or deferral and for procedural optimisation of percutaneous coronary intervention (PCI) results. Despite accumulating evidence and positive guideline recommendations, the adoption of invasive physiology has remained quite low, mainly due to technical and economic issues as well as to operator-resistance to change. Coronary image-based computational physiology has been recently developed, with promising results in terms of accuracy and a reduction in computational time, costs, radiation exposure and risks for the patient. Lastly, the integration of intracoronary imaging and physiology allows for individualised PCI treatment, aiming at complete relief of ischaemia through optimised morpho-functional immediate procedural results. Instead of a conventional state-of-the-art review, this A to Z dictionary attempts to provide a practical guide for the application of coronary physiology in the catheterisation laboratory, exploring several methods, their pitfalls, and useful tips and tricks.

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Editorial commentFunctional assessment of bypass grafts by fractional flow reserve

Cited by 5 publications

References 4 publications

Association Between Adherence to Fractional Flow Reserve Treatment Thresholds and Major Adverse Cardiac Events in Patients With Coronary Artery Disease

Association Between Adherence to Fractional Flow Reserve Treatment Thresholds and Major Adverse Cardiac Events in Patients With Coronary Artery Disease

Transient right internal thoracic arterial graft kink related to respiratory movements: Documentation of its existence, relevance and proposed management

Coronary physiology in the catheterisation laboratory: an A to Z practical guide

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