Usefulness of fractional flow reserve to improve diagnostic efficiency in patients with non-ST elevation myocardial infarction

Carrick, D., Behan, M., Foo, F., Christie, J., Hillis, W. S., Norrie, J., Oldroyd, K. G. and Berry, C. (2013) Usefulness of fractional flow reserve to improve diagnostic efficiency in patients with non-ST elevation myocardial infarction. American Journal of Cardiology, 111(1), pp. 45-50. (doi:10.1016/j.amjcard.2012.08.046)

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Publisher's URL: http://dx.doi.org/10.1016/j.amjcard.2012.08.046

Abstract

Myocardial fractional flow reserve (FFR) has emerging clinical utility and prognostic value in medically stabilized patients with non–ST-segment elevation myocardial infarction (NSTEMI). The aim of this study was to investigate whether measurement of FFR compared to coronary angiography alone improves diagnostic efficiency in patients with NSTEMIs. One hundred consecutive patients with NSTEMIs who had previously undergone clinically indicated FFR measurements were included. In a simulated decision exercise, 5 interventional cardiologists retrospectively and independently reviewed the clinical history and coronary angiogram of each patient and then made a treatment decision. FFR results were then disclosed, and the same cardiologists were asked to review their initial treatment decisions. A p value <0.05 indicates a difference between cardiologists. The proportion of patients allocated to each treatment option initially differed among the 5 cardiologists (p = 0.0061). Forty-two percent of all FFR measurements were made in culprit lesions. After FFR disclosure, the number of patients in whom the treatment decisions made by each cardiologist independently conformed (and so represented the majority with ≥3 of the 5 cardiologists) increased from 65% to 91% (p = 0.0094). After FFR disclosure, the cardiologists changed their initial treatment plans in 46% of patients (p = 0.0016). Changes in favor of medical therapy occurred in 24% of patients (p = 0.0016), and this increase was associated with reductions in “deferred” management (p = 0.0067), single-vessel percutaneous coronary intervention (p = 0.0052), and multivessel percutaneous coronary intervention (p = 0.046). In conclusion, FFR measurement reduced diagnostic variability and changed cardiologists' treatment decisions for patients with NSTEMIs.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Norrie, Prof John and Oldroyd, Dr Keith and Carrick, Dr David and Hillis, Professor William
Authors: Carrick, D., Behan, M., Foo, F., Christie, J., Hillis, W. S., Norrie, J., Oldroyd, K. G., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:American Journal of Cardiology
Publisher:Elsevier
ISSN:0002-9149
ISSN (Online):1879-1913
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
575371Fractional Flow Reserve versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes: a Developmental Clinical StudyColin BerryBritish Heart Foundation (BHF)PG/11/55/28999RI CARDIOVASCULAR & MEDICAL SCIENCES