Angiography-derived fractional flow reserve was associated with similar 2-year MACE rates compared to pressure wire assessment in both PCI (HR 1.01; 95% CI 0.85-1.20) and non-PCI patients.
Cohort (n=466,535)
Yes
Does Angio-FFR guidance yield comparable clinical outcomes to pressure wire-based assessment in patients undergoing coronary angiography?
Angio-FFR guidance during coronary angiography is associated with comparable 2-year clinical outcomes to traditional pressure wire-based assessment in real-world US Medicare patients.
Effect estimate: HR 1.01 (95% CI 0.85 - 1.20)
Absolute Event Rate: 24.8% vs 23.5%
Background: Angiography-derived fractional flow reserve (Angio-FFR) is an emerging tool for guiding percutaneous coronary intervention (PCI). Its uptake and outcomes compared to pressure wire (PW)-based assessment in the US are unknown. Methods: We conducted a cohort study of US Medicare beneficiary data from 1 January 2019 to 31 December 2024. Propensity score matching (1:3) of Angio-FFR to PW was performed in patients who underwent PCI during the same procedure, and separately among those who did not undergo PCI during the same procedure. The primary outcome was the cumulative incidence of major adverse cardiovascular events (MACE) through 2 years, including all-cause death, myocardial infarction (MI) and repeat revascularization. Secondary outcomes included individual MACE components, 30-day acute kidney injury and 30-day major bleeding. Falsification endpoints (hospitalization for pneumonia and hip fracture) were used to assess unmeasured confounding. Results: Of 466,535 angiograms that included intra-procedural physiologic assessment, 1.00% (N=4,672) used Angio-FFR. Annual use increased from 0.47% in 2019 to 3.85% in 2024. Among PCI patients, 1,591 Angio-FFR and 4,773 PW matched PCI patients had similar MACE rates through 2 years (24.8% vs 23.5%; HR 1.01, 95% CI 0.85 - 1.20). Secondary outcomes and falsification endpoints were not significantly different. In non-PCI patients, 2,532 Angio-FFR and 7,596 PW matched patients also had similar MACE through 2 years (24.1% vs 23.9%; HR 0.97, 95% CI 0.84 - 1.11). Conclusions: Angio-FFR usage in the US is modest but increasing. Angio-FFR guidance during angiography versus PW was associated with comparable outcomes through 2 years.
Koo et al. (Sat,) conducted a cohort in Coronary artery disease undergoing angiography (n=466,535). Angiography-derived fractional flow reserve (Angio-FFR) vs. Pressure wire (PW)-based assessment was evaluated on Cumulative incidence of major adverse cardiovascular events (MACE) through 2 years, including all-cause death, myocardial infarction (MI) and repeat revascularization (HR 1.01, 95% CI 0.85 - 1.20). Angiography-derived fractional flow reserve was associated with similar 2-year MACE rates compared to pressure wire assessment in both PCI (HR 1.01; 95% CI 0.85-1.20) and non-PCI patients.