European Heart Journal Advance Access originally published online on September 1, 2005
European Heart Journal 2005 26(24):2623-2629; doi:10.1093/eurheartj/ehi484
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One-year outcome of patients submitted to routine fractional flow reserve assessment to determine the need for angioplasty
Department of Cardiology, EA 3920, University Hospital Jean-Minjoz, Boulevard Fleming, 25030 Besancon Cedex, France
Received 3 June 2005; revised 11 July 2005; accepted 11 August 2005; online publish-ahead-of-print 1 September 2005.
* Corresponding author. Tel: +33 381 66 85 39; fax: +33 381 66 85 82. E-mail address: francois.schiele{at}ufc-chu.univ-fcomte.fr
Aims In patients submitted to coronary angiography, fractional flow reserve (FFR) assessment by a pressure wire can be used to guide the decision for revascularization. Routine application of FFR assessment and 1-year outcome of patients are poorly documented. The aim of this study was to report a 4-year single-centre experience where the use of FFR for decision making in equivocal lesions is encouraged.
Methods and results A prospective registry was designed to collect clinical and angiographic characteristics, as well as 1-year clinical follow-up for all patients submitted to FFR assessment. The decisional cut-off point for revascularization was 0.80. Over a 4-year period, out of 6415 coronary angiographies, FFR was measured in 407 (6.3%) patients (469 lesions). FFR was assessed through 4 or 5 Fr diagnostic catheters in 330 (81%). Median FFR value was 0.87 (0.80; 0.93). On the basis of FFR results, 271 (67%) patients were treated with medical therapy alone. A subset of 71 (17%) patients were not treated in accordance with the results of FFR. All patients but four (i.e. 99%) had 1-year clinical follow-up. Three hundred and forty four (85%) were free from clinical event, six (1.5%) patients died, five (4%) had an acute coronary syndrome, and 20 (5%) underwent target-vessel revascularization. Event-free survival was comparable in patients with vs. without revascularization (0.94±0.02 and 0.93±0.01, respectively). Patients had significantly better 1-year outcome when treated in accordance with the results of the FFR assessment.
Conclusion In routine practice, FFR assessment during diagnostic angiography was performed in 6.3%. On the basis of FFR, two-thirds of patients with ‘intermediate’ lesions were left unrevascularized, with a favourable outcome, when FFR was above 0.80. These data suggest that routine use of FFR during diagnostic catheterization is feasible, safe, and provide help to guide decision making.
Key Words: Coronary angioplasty • Fractional flow reserve • Stent
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