Journal
EUROPEAN HEART JOURNAL
Volume 34, Issue 43, Pages 3353-3361Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/eht404
Keywords
Coronary Disease; Stents; Fractional Flow Reserve; Prognosis
Categories
Funding
- Cardio Vascular Research Foundation, Seoul, Korea
- Korea Healthcare Technology Research and Development Project, Ministry of Health and Welfare, Korea [A120711]
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Aims We evaluated the impact of the routine use of fractional flow reserve (FFR) on the practice and outcomes of percutaneous coronary intervention (PCI). Methods and results Between January 2008 and December 2011, the rate of FFR use during PCI increased from 1.9 to 50.7% after the introduction of routine FFR use (P < 0.001). A total of 5097 patients (2699 patients before and 2398 after the routine use of FFR) underwent PCI at an academic hospital in Korea; of those, stent implantation was deferred in 475 patients. We used propensity score (PS) matching to compare the rates of the primary endpoint [death, myocardial infarction (MI), or repeat revascularization] at 1 year the cohort before and after the routine use of FFR. In the PS-matched cohort (2178 pairs), the median number of lesions per patient was 2 [inter-quartile range (IQR) 1-2] before vs. 2 (IQR 1-2) after the routine FFR use (P = 0.68); the median number of stents implanted per patient was 2 (IQR 1-3) vs. 1 (IQR 1-2), respectively (P < 0.001). The rates of the primary endpoint at 1 year was significantly lower in patients after the routine FFR use vs. patients before the routine use of FFR (hazard ratio 0.55; 95% confidence interval 0.43-0.70; P < 0.001). This was primarily due to a reduction in peri-procedural MI and repeat revascularization. Conclusion Routine measurement of FFR in daily practice appeared to be associated with less use of stents and an improvement in clinical outcomes.
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