Does Routine Pressure Wire Assessment Influence Management Strategy at Coronary Angiography for Diagnosis of Chest Pain?
Why the study?
Does routine measurement of FFR at coronary angiography change management strategy in patients with stable chest pain?
Population
200 patients with stable chest pain undergoing coronary angiography for clinical indications
Comparison
Routine measurement of fractional flow reserve… vs Coronary angiography alone
Design
Cohort
Authors
Discussion
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Member takes
Implication
May support incorporating FFR into diagnostic angiography for stable chest pain; hypothesis-generating for clinical outcomes.
Key Points
- To determine whether routine measurement of fractional flow reserve during diagnostic coronary angiography alters lesion assessment and patient management strategies in stable chest pain.
- Interventional trial (NCT01070771) enrolling 200 patients with stable chest pain undergoing diagnostic coronary angiography.
- A supervising cardiologist recorded significant stenoses and established an initial treatment strategy based on visual angiography alone.
- An interventional cardiologist measured fractional flow reserve in all patent arteries with a diameter ≥2.25 mm, after which the management plan was reevaluated upon data disclosure.
- Disclosure of fractional flow reserve data altered the visual angiography management plan in 26% of patients and modified the number and localization of functional stenoses in 32%.
- Of 72 patients initially recommended for optimal medical therapy based on angiography, 9 (13%) were reassigned to revascularization after pressure wire evaluation.
- Of 89 patients managed with optimal medical therapy following fractional flow reserve assessment, 25 (28%) would have undergone revascularization based on angiography alone.
Structured PICO
Does routine measurement of FFR at coronary angiography change management strategy in patients with stable chest pain?
P
Population
200 patients with stable chest pain undergoing coronary angiography for clinical indications
I
Intervention
Routine measurement of fractional flow reserve (FFR) in all patent coronary arteries of stentable diameter (≥2.25 mm) in addition to coronary angiography
C
Comparator
Coronary angiography alone
O
Outcome
Change in patient management plan (optimal medical therapy alone, percutaneous coronary intervention, coronary artery bypass grafting, or more information required) and change in number/localization of functional stenoses
Routine FFR measurement during diagnostic coronary angiography significantly alters the clinical management plan in over a quarter of patients with stable chest pain compared to angiography alone.
Cite This Study
Curzen et al. (2014) studied this question.