FFR / Sant’ Anna

Influence of Routine Assessment of Fractional Flow Reserve on Decision Making During Coronary Interventions

Sant'Anna FM, Silva EE, Batista LA, Ventura FM, Barrozo CA, Pijls NH.

Am J Cardiol. 2007 Feb 15; 99(4):504-8.

OBJECTIVES:

The aim of this study in patients admitted for elective percutaneous intervention (PCI) was to evaluate the change in strategy if the decision to intervene was based on FFR measurement rather than on angiographic assessment.

METHODS:

• 250 patients
• Patients scheduled for PCI
• All stenoses > 50 % by visual estimation and initially se-lected to be stented by 3 independent reviewers were assessed by FFR measurements
• If FFR was < 0.75, stenting was performed; if FFR was > 0.75, no interventional treatment was given

SUMMARY:

• Optimal pressure measurements were obtained in 452 lesions (96 %).
• Diameter stenosis was 62 ± 12 %, and FFR was 0.67 ± 0.17 for the entire group.
• In 68 % of the stenoses, initial strategy as assessed from the angiogram was followed.
• In 32 % of the stenoses, there was a change in the planned approach based on FFR.
• Of all changes in strategy, an initially selected lesion was deferred in 22% of the stenoses, and a nonplanned PCI was performed in 10% of all stenoses.
• In 48 % of the patients, there was > 1 lesion in which the treatment decision was changed after physiologic measurements.

CONCLUSIONS:

In this prospective, nonselective, but complete study representing the real world of PCI, 32 % of the coronary stenoses and 48 % of patients would have received a different treatment if the decision had been based on angiography only, stressing the utility of physiologic assessment in refining decision making during PCI.

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