Decision Making Using Fractional Flow Reserve is Associated With Lower Rates of Incomplete Revascularization Compared With Angiographic Guided Decision Making Amongst Patients With NSTEMI

Layland, J. J. et al. (2017) Decision Making Using Fractional Flow Reserve is Associated With Lower Rates of Incomplete Revascularization Compared With Angiographic Guided Decision Making Amongst Patients With NSTEMI. American College of Cardiology 66th Annual Scientific Session (ACC.17), Washington, D.C., USA, 17-19 Mar 2017. p. 1057. (doi: 10.1016/s0735-1097(17)34446-7)

Abstract

Background: Multivessel coronary disease is common in patients with acute coronary syndromes (ACS). Moreover, incomplete revascularisation has been associated with adverse outcomes in this patient population. Optimising revascularization decisions is therefore clinically important. Methods: Using data from the previously published FAMOUS NSTEMI study, incomplete revascularisation was classified based on the presence of an artery with a residual diameter stenosis of >50% (Core lab). The study protocol for revascularization decisions was an FFR≤0.80 (FFR-group) or a lesion with a diameter stenosis (DS) cut-off >50% (angiography-guided group). Results: Three hundred and fifty patients were randomised (n=176 FFR-guided group, n=174 angiography-guided group), 136 (77.3%) and 151 (86.8%) patients were revascularized by PCI or CABG in the FFR-guided group and angiography-guided groups, respectively (p=0.022). 309 patients had at least one lesion ≥50% severity in an artery amenable to revascularisation. Incomplete revascularisation occurred in 32 (22.7%) of 141 subjects in the FFR-guided group and in 82 (48.8%) of 168 subjects in the angiography-guided group (p<0.0001). In patients treated by PCI, incomplete revascularisation occurred in 24 (19.7%) of 122 subjects in the FFR-guided group and 64 (46%) of 139 subjects in the angiography-guided group (p<0.0001). When a stenosis threshold of ≥70% stenosis severity was used, incomplete revascularisation values remained higher in the angiographic guided arm but did not reach statistical significance (FFR 19.7% vs. Angiography-guided 26.5%, p=0.23). There was no difference in MACE at 12 months between the two groups. Conclusions: In patients with NSTEMI who were randomly assigned to FFR guided management, revascularisation was more often complete than when guided by an angiography-guided strategy.

• Item Type: Conference or Workshop Item
• Additional Information: Conference abstract published in Journal of the American College of Cardiology 69(11 Supplement): 1057.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McEntegart, Dr Margaret and Balachandran, Dr Bala and Eteiba, Professor Hany and McConnachie, Professor Alex and Shaukat, Dr Aadil and Lee, Matthew and Petrie, Professor Mark and Oldroyd, Dr Keith and Layland, Dr Jamie and Watkins, Dr Stuart and Carberry, Dr Jaclyn and Berry, Professor Colin
• Authors: Layland, J. J., Carberry, J., May, V. T.Y., Lee, M., Eteiba, H., Lindsay, M., Petrie, M., McEntegart, M., Watkins, S., Shaukat, A., Oldroyd, K., Curzen, N., Sood, A., Balachandran, K., Das, R., Junejo, S., Hannah, A., Stewart, A., Henderson, R., McConnachie, A., and Berry, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• ISSN: 0735-1097
• Published Online: 16 March 2017