What About All the Recent Negative FFR Trials?

What can we learn from 4 recent RCT of FFR published or presented in 2021? First, study design for diagnostic strategies must focus on discordant decisions.14 Second, composite endpoints for PCI should discard mortality and focus on vessel-level outcomes for spontaneous MI. Third, initial PCI must be included when calculating the total amount of TVR. Fourth, ultrahigh rates of FFR<0.8 do not change treatment decisions from an angiographic-based strategy. Finally, although PCI is a reasonable option for patients with severe multivessel disease, CABG remains better.

Automated summary

From the four recent RCTs on FFR published or presented in 2021, we have learned several important lessons: study design should focus on discordant decisions; composite endpoints for PCI should prioritize vessel-level outcomes over mortality; initial PCI must be considered when calculating the total amount of TVR; ultrahigh rates of FFR<0.8 do not influence treatment decisions based on angiography; and although PCI is a reasonable option, CABG yields better outcomes for patients with severe multivessel disease.