Fractional flow reserve guided percutaneous coronary intervention results in reduced ischemic myocardium and improved outcomes
Abhishek C. Sawant MD, MPH
Department of Medicine, Division of Cardiology, State University of New York at Buffalo, and Buffalo VA Healthcare System, Buffalo, New York
Dr's Sawant and Bhardwaj contributed equally to this study.
Search for more papers by this authorAishwarya Bhardwaj MD
Department of Medicine, Division of Cardiology, State University of New York at Buffalo, and Buffalo VA Healthcare System, Buffalo, New York
Dr's Sawant and Bhardwaj contributed equally to this study.
Search for more papers by this authorKinjal Banerjee MBBS
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorYash Jobanputra MBBS
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorArnav Kumar MD
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorParth Parikh MD
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorKrishna C. Kandregula MBBS
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorKanhaiya Poddar MBBS
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorStephen G. Ellis MD
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorRavi Nair MD
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorJohn Corbelli MD
Department of Medicine, Division of Cardiology, State University of New York at Buffalo, and Buffalo VA Healthcare System, Buffalo, New York
Search for more papers by this authorCorresponding Author
Samir Kapadia MD
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Correspondence Samir Kapadia, MD, Professor of Medicine, Director Cardiac Catheterization Laboratory, Cleveland Clinic, 9500 Euclid, J2-3 Cleveland, OH 44195. Email: [email protected]Search for more papers by this authorAbhishek C. Sawant MD, MPH
Department of Medicine, Division of Cardiology, State University of New York at Buffalo, and Buffalo VA Healthcare System, Buffalo, New York
Dr's Sawant and Bhardwaj contributed equally to this study.
Search for more papers by this authorAishwarya Bhardwaj MD
Department of Medicine, Division of Cardiology, State University of New York at Buffalo, and Buffalo VA Healthcare System, Buffalo, New York
Dr's Sawant and Bhardwaj contributed equally to this study.
Search for more papers by this authorKinjal Banerjee MBBS
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorYash Jobanputra MBBS
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorArnav Kumar MD
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorParth Parikh MD
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorKrishna C. Kandregula MBBS
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorKanhaiya Poddar MBBS
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorStephen G. Ellis MD
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorRavi Nair MD
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorJohn Corbelli MD
Department of Medicine, Division of Cardiology, State University of New York at Buffalo, and Buffalo VA Healthcare System, Buffalo, New York
Search for more papers by this authorCorresponding Author
Samir Kapadia MD
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Correspondence Samir Kapadia, MD, Professor of Medicine, Director Cardiac Catheterization Laboratory, Cleveland Clinic, 9500 Euclid, J2-3 Cleveland, OH 44195. Email: [email protected]Search for more papers by this authorAbstract
Objectives
To determine if fractional flow reserve guided percutaneous coronary intervention (FFR-guided PCI) is associated with reduced ischemic myocardium compared with angiography-guided PCI.
Background
Although FFR-guided PCI has been shown to improve outcomes, it remains unclear if it reduces the extent of ischemic myocardium at risk compared with angiography-guided PCI.
Methods
We evaluated 380 patients (190 FFR-guided PCI cases and 190 propensity-matched controls) who underwent PCI from 2009 to 2014. Clinical, laboratory, angiographic, stress testing, and major adverse cardiac events [MACE] (all-cause mortality, recurrence of MI requiring PCI, stroke) data were collected.
Results
Mean age was 63 ± 11 years; the majority of patients were males (76%) and Caucasian (77%). Median duration of follow up was 3.4 [Range: 1.9, 5.0] years. Procedural complications including coronary dissection (2% vs. 0%, P = .12) and perforation (0% vs. 0%, P = 1.00) were similar between FFR-guided and angiography-guided PCI patients. FFR-guided PCI patients had lower unadjusted (14.7% vs. 23.2%, P = .04) and adjusted [OR = 0.58 (95% CI: 0.34–0.98)] risk of repeat revascularization at one year. FFR-guided PCI patients were less likely (23% vs. 32%, P = .02) to have ischemia and had lower (5.9% vs. 21.1%, P < .001) ischemic burden (moderate-severe ischemia) on post-PCI stress testing. Presence of ischemia post-PCI remained a strong predictor of MACE [OR = 2.14 (95%CI: 1.28–3.60)] with worse survival compared to those without ischemia (HR = 1.63 (95% CI: 1.06–2.51).
Conclusion
Compared with angiography-guided PCI, FFR-guided PCI results in less repeat revascularization and a lower incidence of post PCI ischemia translating into improved survival, without an increase in complications.
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