Does routine use of fractional flow reserve (FFR) reduce the composite of death, MI, or repeat revascularization in patients undergoing PCI?
Routine incorporation of fractional flow reserve (FFR) during PCI in real-world practice is associated with reduced stent usage and improved 1-year clinical outcomes.
AIMS: We evaluated the impact of the routine use of fractional flow reserve (FFR) on the practice and outcomes of percutaneous coronary intervention (PCI). METHODS AND RESULTS: Between January 2008 and December 2011, the rate of FFR use during PCI increased from 1.9 to 50.7% after the introduction of routine FFR use (P < 0.001). A total of 5097 patients (2699 patients before and 2398 after the routine use of FFR) underwent PCI at an academic hospital in Korea; of those, stent implantation was deferred in 475 patients. We used propensity score (PS) matching to compare the rates of the primary endpoint death, myocardial infarction (MI), or repeat revascularization at 1 year the cohort before and after the routine use of FFR. In the PS-matched cohort (2178 pairs), the median number of lesions per patient was 2 inter-quartile range (IQR) 1-2 before vs. 2 (IQR 1-2) after the routine FFR use (P = 0.68); the median number of stents implanted per patient was 2 (IQR 1-3) vs. 1 (IQR 1-2), respectively (P < 0.001). The rates of the primary endpoint at 1 year was significantly lower in patients after the routine FFR use vs. patients before the routine use of FFR (hazard ratio 0.55; 95% confidence interval 0.43-0.70; P < 0.001). This was primarily due to a reduction in peri-procedural MI and repeat revascularization. CONCLUSION: Routine measurement of FFR in daily practice appeared to be associated with less use of stents and an improvement in clinical outcomes. CLINICALTRIALSGOV NUMBER: NCT 01788592.
Park et al. (Wed,) studied this question.