February 1, 2016EuroIntervention
Long-term outcome of FFR-guided PCI for stable coronary artery disease in daily clinical practice: a propensity score-matched landmark analysis
Key result
FFR-guided PCI for stable CAD was associated with a significantly lower rate of death or myocardial infarction compared to angiography-guided PCI (HR 0.63).
Why the study?
Does an FFR-guided treatment strategy improve long-term clinical outcomes compared to an angiography-guided strategy in patients with stable coronary artery disease requiring PCI?
Population
1,716 patients with stable coronary artery disease and at least one 50-89% coronary stenosis thought to…
Comparison
Fractional flow reserve-guided treatment strategy vs Angiography (XA)-guided treatment strategy
Design
Cohort
Follow-up
4 years
Authors
Discussion
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Member takes
Implication
FFR adoption varies in stable CAD PCI; leaves open whether it improves outcomes over angiography in routine practice.
Key Points
- Evaluate the clinical utility and long-term outcomes of fractional flow reserve (FFR)-guided versus angiography-guided percutaneous coronary intervention (PCI) in routine practice for stable coronary artery disease.
- Retrospective analysis of 1,716 patients with stable coronary artery disease and 50–89% stenosis selected for PCI, comparing angiography guidance alone (n=962) with FFR guidance (n=754).
- Propensity score matching yielded 957 lesions in the angiography-guided group and 947 lesions in the FFR-guided group, analyzed using a landmark approach at 7 days and from 8 days to 4 years.
- FFR guidance resulted in PCI deferral in 48.8% of lesions (462 lesions) and treatment reallocation in 43% of patients (n=321), predominantly toward medical therapy.
- Periprocedural myocardial infarction within 7 days was reduced by more than half in the FFR-guided group (p>0.05).
- Between 8 days and 4 years of follow-up, FFR guidance significantly lowered the combined risk of death or myocardial infarction (HR 0.63) and myocardial infarction-driven target lesion revascularization (HR 0.35).
Study Design
Type
Cohort (n=1,716)
Structured PICO
Does an FFR-guided treatment strategy improve long-term clinical outcomes compared to an angiography-guided strategy in patients with stable coronary artery disease requiring PCI?
P
Population
1,716 patients with stable CAD and at least one 50-89% coronary stenosis thought to require PCI, followed for up to 4 years.
E
Exposure
Fractional flow reserve (FFR)-guided treatment strategy
C
Comparator
Angiography (XA)-guided treatment strategy
O
Outcome
Combined endpoint of death or myocardial infarction (MI) between 8 days and 4 yearscomposite
Main Result
Hazard Ratio: 0.63
In daily clinical practice, FFR-guided PCI for stable CAD significantly reduces long-term rates of death, myocardial infarction, and target lesion revascularization compared to angiography guidance alone.
Limitations
- Retrospective study design
- Retrospective design
Cite This Study
Backer et al. (2016) conducted a cohort in stable coronary artery disease (n=1,716). FFR-guided PCI vs. Angiography (XA)-guided PCI was evaluated on combined endpoint of death/MI (HR 0.63). FFR-guided PCI for stable CAD was associated with a significantly lower rate of death or myocardial infarction compared to angiography-guided PCI (HR 0.63).