The Role of FFR in Clinical Decision Making in Patients with Moderate Coronary Lesions: a Pilot Study

Overview

Journal Acta Biomed

Specialty General Medicine

Date 2018 Oct 19

PMID 30333462

Citations 3

Authors

Morteza Safi

Mohammad Ali Mehrabi

Saeed Alipour Parsa

Isa Khaheshi

Mohammadreza Naderian

Affiliations

Soon will be listed here.

Abstract

Background And Aim: Applying fractional flow reserve (FFR) recently helped to assess borderline coronary defects and also facilitates assessment of these lesions. The present study aimed to assess cost-effectiveness of FFR in detection of these borderline lesions.

Methods: This cross-sectional study was conducted on140 consecutive patients with 219 diseased arteries who underwent coronary angiography and suffered intermediate coronary lesions.

Results: Of 18 patients who candidate for CABG before FFR, only one patient underwent CABG after determining FFR (P-value<0.05), while 15 patients were scheduled for PCI and 2 patients for medical treatment. Of 122 patients who candidate for PCI, 59 were programmed to underwent PCI after FFR determination(P-value<0.05), while the strategy in 63 patients (47 with one-vessel disease, 15 with two vessel diseases, and 1 with three vessel diseases) was modified to medical treatment. Considering strategy modifying from PCI to medical treatment, 101 stents were saved (P-value<0.05). Also, in change of strategy from CABG to PCI, spending has decreased as much as 77.3% (P-value<0.05). Furthermore, the change of treatment approach from PCI on much number of coronary vessels to PCI on less number of coronary lesions led to saving of 52.2% of costs(P-value<0.05).

Conclusions: In patients with an intermediate coronary lesion, measuring FFR to guide the decision to determine treatment strategy may lead to significant cost savings.

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References

de Bruyne B, Bartunek J, Sys S, Pijls N, Heyndrickx G, Wijns W . Simultaneous coronary pressure and flow velocity measurements in humans. Feasibility, reproducibility, and hemodynamic dependence of coronary flow velocity reserve, hyperemic flow versus pressure slope index, and fractional flow reserve. Circulation. 1996; 94(8):1842-9. DOI: 10.1161/01.cir.94.8.1842. View

de Bruyne B, Baudhuin T, Melin J, Pijls N, Sys S, Bol A . Coronary flow reserve calculated from pressure measurements in humans. Validation with positron emission tomography. Circulation. 1994; 89(3):1013-22. DOI: 10.1161/01.cir.89.3.1013. View

Petraco R, Sen S, Nijjer S, Echavarria-Pinto M, Escaned J, Francis D . Fractional flow reserve-guided revascularization: practical implications of a diagnostic gray zone and measurement variability on clinical decisions. JACC Cardiovasc Interv. 2013; 6(3):222-5. DOI: 10.1016/j.jcin.2012.10.014. View

Suemaru S, Iwasaki K, Yamamoto K, Kusachi S, Hina K, Hirohata S . Coronary pressure measurement to determine treatment strategy for equivocal left main coronary artery lesions. Heart Vessels. 2005; 20(6):271-7. DOI: 10.1007/s00380-005-0849-1. View

Fard-Esfahani A, Assadi M, Saghari M, Mohagheghie A, Fallahi B, Eftekhari M . The role of myocardial perfusion imaging in the evaluation of patients undergoing percutaneous transluminal coronary angioplasty. Hellenic J Cardiol. 2009; 50(5):396-401. View

Trivedi S, Aroney C, Walters D, Bett J . Measurement of myocardial fractional flow reserve is a cost-effective way to identify coronary artery lesions of indeterminate severity that warrant revascularisation. Heart Lung Circ. 2005; 14(4):239-41. DOI: 10.1016/j.hlc.2005.06.001. View

Bech G, de Bruyne B, Pijls N, de Muinck E, Hoorntje J, Escaned J . Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis: a randomized trial. Circulation. 2001; 103(24):2928-34. DOI: 10.1161/01.cir.103.24.2928. View

Hamilos M, Muller O, Cuisset T, Ntalianis A, Chlouverakis G, Sarno G . Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation. 2009; 120(15):1505-12. DOI: 10.1161/CIRCULATIONAHA.109.850073. View

Pijls N, van Schaardenburgh P, Manoharan G, Boersma E, Bech J, Vant Veer M . Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007; 49(21):2105-11. DOI: 10.1016/j.jacc.2007.01.087. View

10.

Lindstaedt M, Yazar A, Germing A, Fritz M, Holland-Letz T, Mugge A . Clinical outcome in patients with intermediate or equivocal left main coronary artery disease after deferral of surgical revascularization on the basis of fractional flow reserve measurements. Am Heart J. 2006; 152(1):156.e1-9. DOI: 10.1016/j.ahj.2006.03.026. View

11.

Wijns W, De Bruyne B, Vanhoenacker P . What does the clinical cardiologist need from noninvasive cardiac imaging: is it time to adjust practices to meet evolving demands?. J Nucl Cardiol. 2007; 14(3):366-70. DOI: 10.1016/j.nuclcard.2007.04.016. View

12.

De Bruyne B, Pijls N, Barbato E, Bartunek J, Bech J, Wijns W . Intracoronary and intravenous adenosine 5'-triphosphate, adenosine, papaverine, and contrast medium to assess fractional flow reserve in humans. Circulation. 2003; 107(14):1877-83. DOI: 10.1161/01.CIR.0000061950.24940.88. View

13.

de Bruyne B, Sarma J . Fractional flow reserve: a review: invasive imaging. Heart. 2008; 94(7):949-59. DOI: 10.1136/hrt.2007.122838. View

14.

Fearon W, Yeung A, Lee D, Yock P, Heidenreich P . Cost-effectiveness of measuring fractional flow reserve to guide coronary interventions. Am Heart J. 2003; 145(5):882-7. DOI: 10.1016/S0002-8703(03)00072-3. View

15.

Reczuch K, Jankowska E, Telichowski A, Porada A, Banasiak W, Ponikowski P . Measurement of fractional flow reserve in patients with multi-vessel coronary artery disease and borderline lesions prevents unnecessary revascularisation procedures. Kardiol Pol. 2004; 60(4):311-19. View

16.

Pijls N, de Bruyne B, Peels K, van der Voort P, Bonnier H, Bartunek J Koolen J . Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996; 334(26):1703-8. DOI: 10.1056/NEJM199606273342604. View

17.

Pijls N, van Gelder B, van der Voort P, Peels K, Bracke F, Bonnier H . Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation. 1995; 92(11):3183-93. DOI: 10.1161/01.cir.92.11.3183. View

18.

Legutko J, Dudek D, Rzeszutko L, Wizimirski M, Dubiel J . Fractional flow reserve assessment to determine the indications for myocardial revascularisation in patients with borderline stenosis of the left main coronary artery. Kardiol Pol. 2005; 63(5):499-506. View

19.

Legalery P, Seronde M, Meneveau N, Schiele F, Bassand J . Measuring pressure-derived fractional flow reserve through four French diagnostic catheters. Am J Cardiol. 2003; 91(9):1075-8. DOI: 10.1016/s0002-9149(03)00151-6. View

20.

Bech G, DROSTE H, Pijls N, de Bruyne B, Bonnier J, Michels H . Value of fractional flow reserve in making decisions about bypass surgery for equivocal left main coronary artery disease. Heart. 2001; 86(5):547-52. PMC: 1729979. DOI: 10.1136/heart.86.5.547. View