Key result
In patients with acute coronary syndrome, the use of FFR, IVUS, or both was associated with lower in-hospital mortality (0.9%, 2.3%, and 0%, respectively) compared to no procedure (3.7%).
Why the study?
Intravascular ultrasound (IVUS) and fractional flow reserve (FFR) are increasingly used in acute coronary syndrome (ACS), but their frequency of use, safety, and impact on short- and long-term survival in Poland required evaluation.
Does the use of IVUS and/or FFR improve short- and long-term survival in patients with acute coronary syndrome treated invasively?
Cohort (n=103,849)
Yes
Does the use of IVUS and/or FFR improve short- and long-term survival in patients with acute coronary syndrome treated invasively?
The use of IVUS and FFR in ACS patients is associated with lower in-hospital mortality but does not significantly affect 30-day or 1-year survival.
Associated lower in-hospital mortality with FFR/IVUS in ACS should not change practice; leaves open long-term benefits pending randomized trials.
BACKGROUND: Intravascular ultrasound (IVUS) and fractional flow reserve (FFR) are invasive procedures increasingly used in treating acute coronary syndrome (ACS). AIMS: This study aimed to evaluate the frequency of IVUS and FFR use in patients with ACS in Poland and to assess the safety of these procedures as well as their impact on short- and long-term survival. METHODS AND RESULTS: This retrospective study included 103849 patients enrolled in the Polish Registry of Acute Coronary Syndromes in 2017-2020. IVUS was performed in 1727 patients, FFR in 1537 patients, and both procedures in 37 patients. The frequency of performing FFR in ACS patients increased over the years from 1.3% to 1.8% (P <0.0001) and IVUS from 1.7% to 2.3% (P <0.0001). In the FFR and/or IVUS group, a similar incidence of stroke, reinfarction, target vessel revascularization, and major bleeding was observed while in-hospital mortality was lower (0% for IVUS + FFR vs. 0.9% for FFR vs. 2.3% for IVUS vs. 3.7 for no procedure; P <0.0001). FFR and IVUS did not affect the 30-day and one-year prognosis. CONCLUSION: In recent years, the number of FFR and IVUS procedures performed in patients with ACS in Poland has increased. There was lower in-hospital mortality in the FFR and/or IVUS group in ACS patients, and no differences in the incidence of stroke, reinfarction, target vessel revascularization, and major bleeding were observed. Performing FFR and IVUS in ACS patients does not significantly affect 30-day or one-year mortality.
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Kaziród-Wolski et al. (2023) conducted a cohort in Acute coronary syndrome (n=103,849). Intravascular ultrasound (IVUS) and/or fractional flow reserve (FFR) vs. No IVUS or FFR procedure was evaluated on In-hospital mortality (p=<0.0001). In patients with acute coronary syndrome, the use of FFR, IVUS, or both was associated with lower in-hospital mortality (0.9%, 2.3%, and 0%, respectively) compared to no procedure (3.7%).
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