Six-Year Follow-Up of Fractional Flow Reserve-Guided Versus Angiography-Guided Coronary Artery Bypass Graft Surgery

Fournier, Stéphane; Tóth, Gábor G.; Bruyne, Bernard De; Johnson, Nils P.; Ciccarelli, Giovanni; Xaplanteris, Panagiotis; Μιλκασ, Αναστασιοσ; Strisciuglio, Teresa; Bartúnek, Jozef; Vanderheyden, Marc; Wyffels, Eric; Casselman, Filip; Praet, Frank Van; Stockman, Bernard; Degrieck, Ivan; Barbato, Emanuele

doi:10.1161/circinterventions.117.006368

Cited by 93 publications

(97 citation statements)

References 17 publications

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“…In a subgroup of 155 patients (25%) who underwent repeated coronary angiography for clinical indications, freedom from graft occlusion was higher in the FFR-guided group (21% in angiography-guided group, 5% in FFR-guided group, P = 0.031). The extended 6-year results were recently reported by Fournier and colleagues [34] and included 627 consecutive patients between 2006 and 2010. Both the rate of composite death or myocardial infarction (16% for FFR-guided group, 25% for angiography-guided group, P = 0.020) as well as death alone (11% for FFR-guided group, 18% for angiography-guided group, P = 0.013) were significantly lower in the FFR-guided CABG group.…”

Section: The Evolution Of Ffr In Coronary Artery Bypass Graftingmentioning

confidence: 91%

Fractional flow reserve guided coronary artery bypass grafting - new developments and future perspectives

Merwe¹,

Casselman²

2019

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The potential role of fractional flow reserve (FFR) in coronary artery bypass grafting (CABG) planning and post-CABG patency assessment are currently under intense investigation to determine whether the favourable outcomes reported with FFR-guided percutaneous coronary intervention can be translated to surgical practice. This review provides an overview of the principles that guide FFR measurement, the clinical evolution of FFR in CABG practice, the much anticipated outcomes of recent investigations that compare FFR-guided and angiography guided CABG and outlines the potential of alternative technology that may assist in ensuring ongoing improvement in surgical revascularization outcomes.

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Section: The Evolution Of Ffr In Coronary Artery Bypass Graftingmentioning

confidence: 91%

Fractional flow reserve guided coronary artery bypass grafting - new developments and future perspectives

Merwe¹,

Casselman²

2019

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“…As shown in the DEFER trial (Deferral vs Performance of Percutaneous Coronary Intervention of Functionally FFR-Guided CABG Outcomes Non-Significant Coronary Stenosis) and FAME study (Fractional Flow Reserve Versus Angiography for Guiding Percutaneous Coronary Intervention), 11,12 Fournier et al 10 demonstrated that revascularization of ischemic lesions while deferring bypass on those without ischemia produces superior clinical results. Although surgeons and interventional cardiologists alike are predisposed to think that their revascularization procedures are purely beneficial or protective, the evidence suggests otherwise.…”

Section: See Article By Fournier Et Almentioning

confidence: 99%

“…With this in mind, in this issue of Circulation: Cardiovascular Interventions, Fournier et al 10 now report the extended 6-year results of their initial study 9 in which arteries were grafted based on either the angiographic severity or an FFR ≤0.80. Outcomes in 627 consecutive patients between 2006 and 2010 were analyzed by group; 198 having an FFR-guided approach on at least 1 artery and 429 having the standard angiographicguided approach.…”

Section: See Article By Fournier Et Almentioning

confidence: 99%

“…The primary end points were overall death and MI and major adverse cardiovascular events including target vessel revascularization. At a mean of 87-month follow-up, Fournier et al 10 found that both the rate of composite death or MI as well as death alone was significantly lower in the FFRguided CABG group than in the angiographic-guided group. By Cox multivariate regression analysis, FFR-guidance was an independent predictor of reduced death or MI (P=0.008).…”

Section: See Article By Fournier Et Almentioning

confidence: 99%

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FFR-Guided CABG

Kern

Seto

2018

Circ: Cardiovascular Interventions

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“…SYNTAX 3 Revolution Study thus provides evidence base and a window of opportunity for incorporating the radiologist in the Heart-Team. The surgeon may thus serendipitously find an ally in the Heart-Team.The concept of physiological guidance to myocardial revascularization is now extended to CABG too and has been validated with a lower rate of all-cause mortality or myocardial infarction (16% vs 25%, p − 0.02) [4]. The results of the ongoing Graft patency after FFR-guided Versus Angio-guided CABG (GRAFFITI) trial too are keenly awaited and are likely to add weightage to this recommendation.…”

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confidence: 99%

CABG and PCI—just as we said it!

Yadava

2018

Indian J Thorac Cardiovasc Surg

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Let me preempt any presumption of the reader of my being a surgical hawk-I am not decrying percutaneous coronary interventions (PCI), but to the very contrary, I acknowledge, loud and clear, that PCI is one of the greatest boons to the society-albeit with a caveat. Just akin to salt in food, in right amounts-an elixir, but a little more or less and it messes up the taste-PCI too has its rightful place in the armamentarium for coronary artery disease (CAD), but only when optimally used. Cardiac surgeons have never challenged PCI, but have been bemoaning the fact that PCI has been overused over the last decade or so. That Bintuitive wisdom^is now being given the wind of Bevidence^as acknowledged by the recent European Society of Cardiology (ESC)/European Association of Cardiothoracic Surgeons (EACTS) guidelines released during the recent meeting in Munich in August 2018 [1]. That clinical profile matters has been acknowledged by the Clinical / Functional SYNergy between PCI with TAXus and Cardiac Surgery (SYNTAX) Score, which was shown to be superior in risk prediction than the anatomical SYNTAX Score. But now, even in anatomical SYNTAX scores less than 23, in patients with diabetes, coronary artery bypass graft (CABG) surgery has been shown to have superior outcomes to PCI. Left ventricular (LV) dysfunction and heart failure are other major clinical phenotypes with surgical superiority [1]. Further recent guidelines prioritize completeness of revascularization as the Braison d'etre^of the decision making process and that surgery provides more complete revascularization than PCI is a Bgiven.^So moving forwards, with better understanding of the indications and outcomes of the two major modalities of treatment of CAD, viz PCI and CABG, without giving a short shrift to the third modality-the medical treatment-which in fact may supersede the other two, especially in stable CAD, CABG is likely to re-discover itself.The recent publication of the SYNTAX II [2] and the SYNTAX III Revolution [3] trials too serves the surgical community well, as the gatekeeper role seems to be slipping out of the cardiologist's domain into the radiologist's. Time is not far, when the latter would sit on jury, as a neutral ombudsman, adjudicating on the optimum mode of treatment in an index case. This chutzpah emanates from the ever refining accuracy of the coronary computed tomography (CT) angiography-bordering, but not yet quite, challenging cine angiography. The evidence generated by the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) and the FAME 2 studies on physiological assessment of coronary stenosis has been given further impetus and a thumbs up by the SYNTAX III Trial, which clearly showed that the outcomes were better with Fractional Flow Reserve Computed Tomography (FFR CT)based PCI over classical cine angiography-based myocardial revascularization [3]. SYNTAX 3 Revolution Study thus provides evidence base and a window of opportunity for incorporating the radiologist in the Heart-Team. The surgeon may ...

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Six-Year Follow-Up of Fractional Flow Reserve-Guided Versus Angiography-Guided Coronary Artery Bypass Graft Surgery

Abstract: FFR-guided CABG is associated with a significant reduction in the rate of overall death or myocardial infarction at 6-year follow-up as compared with angiography-guided CABG.

Cited by 93 publications

References 17 publications

Fractional flow reserve guided coronary artery bypass grafting - new developments and future perspectives

Fractional flow reserve guided coronary artery bypass grafting - new developments and future perspectives

FFR-Guided CABG

CABG and PCI—just as we said it!

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