Long-Term Follow-Up After Fractional Flow Reserve–Guided Treatment Strategy in Patients With an Isolated Proximal Left Anterior Descending Coronary Artery Stenosis

Müller, Olivier; Mangiacapra, Fabio; Ntalianis, Argyrios; Verhamme, Katia; Trana, Catalina; Hamilos, Michalis; Bartúnek, Jozef; Vanderheyden, Marc; Wyffels, Eric; Heyndrickx, Guy R.; Rooij, Frank J.A. van; Witteman, Jacqueline C. M.; Hofman, Albert; Wijns, William; Barbato, Emanuele; Bruyne, Bernard De

doi:10.1016/j.jcin.2011.09.007

Cited by 106 publications

(58 citation statements)

References 31 publications

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“…The use of PCI of intermediate stenosis without evidence of ischemia is frequent in clinical practice, but its benefit is highly debated. When revascularization is based mainly on angiographic guidance, a number of hemodynamically non-significant stenoses will be revascularized [21], and revascularization of non-ischemic lesions is controversial [22][23][24]. A recent analysis in patients with left main coronary disease comparing revascularization with deferred revascularization, suggested a higher incidence of adverse cardiovascular events in both the groups [1].…”

Section: Discussionmentioning

confidence: 99%

“…Although coronary angiography often underestimates or overestimates the functional severity of a lesion, it is still the standard technique for guiding PCI in patients with multivessel CAD [26]. Coronary pressure-derived FFR is an invasive index used to identify stenosis responsible for reversible ischemia, and is well validated [21,27,28]. An FFR of 0.80 discriminates coronary stenosis responsible for ischemia with an accuracy >90% [29,30].…”

Section: Discussionmentioning

confidence: 99%

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Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis

Xiu¹,

Chen²,

Zheng³

et al. 2016

CIM

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*Contributed equally to this work.Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis Methods: Prospective and retrospective studies comparing FFR-guided vs. angiography-guided PCI in patients with multi-vessel CAD were identified from medical databases by two independent reviewers using the terms "percutaneous coronary intervention, fractional flow reserve, angiography, coronary heart disease, major adverse cardiac events (MACE) and myocardial infarction". The primary outcome was the number of stents placed, and the secondary outcomes were procedure time, mortality, myocardial infarction (MI) and MACE rates.Results: Seven studies (three retrospective and four prospective), which included 49,517 patients, were included in this review. A total of 4,755 patients underwent FFR, while 44,697 received angiography-guided PCI. The mean patient age ranged from 58 to 71.7 years. The average number of stents used in FFR patients ranged from 0.3-1.9, and in angiography-guided PCI patients ranged from 0.7-2.7. Analysis indicated there was a greater number of stents placed in the angiography-guided group compared with the FFR group (pooled difference in means: -0.64, 95% confidence interval [CI]: -0.81 to -0.47, P < 0.001). There were no differences in the secondary outcomes between the two groups.Conclusions: Both procedures produce similar clinical outcomes, but the fewer number of stents used with FFR may have clinical as was as cost implications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis

Xiu¹,

Chen²,

Zheng³

et al. 2016

CIM

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“…[1][2][3] An FFR value ≤0.75 is almost uniformly associated with signs of ischemia, [4][5][6][7][8][9] whereas an FFR >0.80 is usually associated with the absence of ischemia. Based on numerous randomized trials [2][3][4][5] and registries in most subsets of lesions and patients, the threshold value of 0.80 has been widely accepted to guide clinical decision making.…”

mentioning

confidence: 99%

Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease

Adjedj¹,

Bruyne²,

Floré³

et al. 2016

Circulation

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125

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Background— The fractional flow reserve (FFR) value of 0.75 has been validated against ischemic testing, whereas the FFR value of 0.80 has been widely accepted to guide clinical decision making. However, revascularization when FFR is 0.76 to 0.80, within the so-called gray zone, is still debatable. Methods and Results— From February 1997 to June 2013, all patients with single-segment disease and an FFR value within the gray zone or within the 2 neighboring FFR strata (0.70–0.75 and 0.81–0.85) were included. Study end points consisted of major adverse cardiovascular events (death, myocardial infarction, and any revascularization) up to 5 years. Of 17 380 FFR measurements, 1459 patients were included. Of them, 449 patients were treated with revascularization and 1010 patients were treated with medical therapy. In the gray zone, the major adverse cardiovascular events rate was similar (37 [13.9%] versus 21 [11.2%], respectively; P =0.3) between medical therapy and revascularization, whereas a strong trend toward a higher rate of death or myocardial infarction (25 [9.4] versus 9 [4.8], P =0.06) and overall death (20 [7.5] versus 6 [3.2], P =0.059) was observed in the medical therapy group. Among medical therapy patients, a significant step-up increase in major adverse cardiovascular events rate was observed across the 3 FFR strata, especially with proximal lesion location. In revascularization patients, the major adverse cardiovascular events rate was not different across the 3 FFR strata. Conclusions— FFR in and around the gray zone bears a major prognostic value, especially in proximal lesions. These data confirm that FFR≤0.80 is valid to guide clinical decision making.

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“…40 A number of other studies also have demonstrated the safety and benefit of deferring the revascularization of lesions that are not physiologically significant based on FFR assessment. [41][42][43] The improved outcomes with FFR-guided PCI in the FAME trial were related to relieving ischemia with revascularization and to minimizing unnecessary revascularization. By achieving a functionally complete revascularization, instead of an anatomically complete one, the benefit of PCI could be maximized while also minimizing the risks of the procedure.…”

Section: Fractional Flow Reservementioning

confidence: 99%

Coronary Artery Bypass Surgery Is Not Underutilized!

Fearon

Harrington

2016

Circulation

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Long-Term Follow-Up After Fractional Flow Reserve–Guided Treatment Strategy in Patients With an Isolated Proximal Left Anterior Descending Coronary Artery Stenosis

Abstract: Medical treatment of patients with a hemodynamically nonsignificant stenosis (FFR ≥ 0.80) in the proximal LAD is associated with an excellent long-term clinical outcome with survival at 5 years similar to an age- and sex-matched control population.

Cited by 106 publications

References 31 publications

Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis

Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis

Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease

Coronary Artery Bypass Surgery Is Not Underutilized!

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