Key result
FFR-guided percutaneous coronary intervention is superior in reducing the risk of major cardiac adverse events, number of stents used, and total cost in patients with multivessel coronary disease.
Why the study?
Visual assessment of coronary stenosis severity via conventional angiography has wide interoperator variability and a weak relationship with hemodynamics.
Does invasive coronary physiology assessment improve outcomes compared to visual assessment in patients with stable coronary disease?
Does invasive coronary physiology assessment improve outcomes compared to visual assessment in patients with stable coronary disease?
The transition from visual anatomical assessment to invasive physiology (such as FFR) for guiding PCI in stable coronary disease reduces adverse events and costs, representing a major paradigm shift in the cardiac catheterization laboratory.
Encourages FFR-guided PCI adoption in multivessel disease; strengthens randomized evidence for physiology-based revascularization.
Visual assessment of coronary stenosis severity using conventional coronary angiography is associated with wide interoperator variability and a weak relationship with hemodynamics. Invasive coronary physiology assessment using fractional flow reserve (FFR) has been shown to be safe and beneficial. Large multicenter randomized trials have demonstrated the superiority of FFR-guided percutaneous coronary intervention in reducing the risk of major cardiac adverse events, number of stents used, and total cost in patients with multivessel coronary disease. FFR requires vasodilatory agents for the microvasculature to induce maximal hyperemia, which carry a slight risk, cost, and effort. Nonhyperemic pressure ratios provide a physiologic metric without vasodilator medications but with more limited clinical outcomes data. The transition from anatomy to physiology for coronary artery disease decision-making represents a cultural sea change in the cardiac catheterization laboratory that requires time and retooling.
No takes yet. Share an insight, caveat, or question.
Elgendy et al. (2021) conducted a review in Stable Coronary Disease. Fractional flow reserve (FFR)-guided percutaneous coronary intervention vs. Visual assessment of coronary stenosis severity was evaluated. FFR-guided percutaneous coronary intervention is superior in reducing the risk of major cardiac adverse events, number of stents used, and total cost in patients with multivessel coronary disease.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: