Based on the results of a Korean study, regular measurement of fractional flow reserve (FFR) was associated to improved clinical outcomes and decreased use of stents in patients undergoing percutaneous coronary intervention (PCI).
According to the study findings, the rate of FFR use over the course of study's site rose from 1.9% in January 2008 to 50.7% in December 2011 (P<.001) as a result of the introduction of ordered routine FFR use in Korea beginning in January 2010.
Seung-Jung Park, MD, with the Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, and peers compared practices and outcomes for PCI among patients at a Korean hospital before (n=2,699) and after (n=2,398) January 2010. The principal substitute to FFR was angioplasty.
Patients who were subjected to PCI following routine FFR use had considerably lower rates of the primary endpoint (death, MI or repeat revascularization) at 1 year as opposed to those who underwent PCI prior to routine FFR use (4.8% vs. 8.6%; HR=0.55; 95% CI, 0.43-0.7). The researchers wrote that this was because of declines in periprocedural MI and repeat revascularization.
There was no significant difference found in all-cause mortality at 1 year between the group undergoing PCI following routine FFR use and those undergoing PCI prior to routine FFR use (after, 1% vs. before, 1.1%; P=.89).
However, the group undergoing PCI following routine FFR use had a lower adjusted rate of death or MI at 1 year (after, 3.3% vs. before, 5%; HR=0.66; 95% CI, 0.49-0.9). Morover, the group undergoing PCI following routine FFR use had a lower adjusted rate of repeat revascularization at 1 year (after, 1.8% vs. before, 3.7%; HR=0.49; 95% CI, 0.34-0.71).
In the propensity-score matched group of 2,178 pairs, the average number of lesions per patient was two (interquartile range [IQR], 1-2) for the group prior to routine FFR use vs. two (IQR, 1-2) for the group following routine FFR use (P=.68); yet, the average number of stents inserted per patient was two (IQR, 1-3) for the group before vs. one (IQR, 1-2) after routine FFR use (P<.001).
Stent implantation was postponed in 475 patients; among them, only one noncardiac death and two repeat revascularizations occurred. Among 987 deferred lesions, 0.6% were revascularized at 1-year follow-up.
Such favorable prognosis of deferred lesions may be related to the absolute lower rate of primary endpoints in our study,” Park, a Cardiology Today’s Intervention Editorial Board member, and his team of researchers noted.
The largest reductions in stent use occurred in the right coronary artery and the left circumflex artery, they reported.
The stenosis-supplied smaller myocardial territories may have a higher chance to have a negative FFR, and subsequently a less chance to receive stent implantation,” Park and peers wrote.
