Abstract 17087: Long-Term Clinical Outcome in Patients Undergoing FFR- vs. Angio-Guided PCI of Coronary Artery By-Pass Graft
Fractional Flow Reserve (FFR) guided percutaneous coronary intervention (PCI) is superior to Angio-guided PCI in stenosis of native coronary arteries.
Objectives: To assess FFR-guided vs. Angio-guided PCI in coronary artery by-pass grafts (CABG).
Methods. We included 220 CABG patients (pts) referred to coronary angiography with at least one intermediate stenosis of an arterial or a venous graft. Pts were divided into: a) FFR-guided group (FFR, n=63), in whom PCI was performed only for stenosis with FFR 50% diameter (%DS). Primary endpoint was major adverse cardio-cerebrovascular events (MACCE) at the follow-up, composed of death, acute coronary syndrome (ACS), target vessel revascularization (TVR) and stroke. Freedom from chest pain was also assessed.
Results. No clinical differences were found between the 2 groups. Angiographic metrics were: %DS, 43.3±15.3% vs. 63.3±12.6%, p<0.01; minimal lumen diameter, 1.14±0.7 vs. 0.65±0.5, p<0.01 (in FFR-guided and Angio-guided group, respectively). PCI was performed in 20 pts (32%) of FFR-guided vs. 86 pts (55%) of Angio-guided group (p=0.002). In FFR-guided pts, arterial grafts had more frequently FFR<0.80 as compared with saphenous vein grafts (81% vs. 19%, p = 0.01). PCI of arterial grafts was more frequent in FFR-guided as compared with Angio-guided group (75% vs. 11%, p<0.01). Yet, PCI of saphenous venous grafts was more frequent in Angio-guided as compared with FFR-guided group (25% vs. 87%, p<0.01). Procedural costs were significantly lower in FFR-guided as compared to Angio-guided group (2240±652 vs 2416±522 €, p=0.03). At 2 years follow-up, no significant difference was found between the 2 groups in MACCE [13 (21%) vs. 45 (30%), p=0.21], TVR [6 (11%) vs. 24 (21%), p=0.19], non-fatal MI [2 (4%) vs. 6 (5%), p = 0.84], stroke [0 (0%) vs. 3 (2%), p = 0.26] and Death [8 (13%) vs. 22 (14%), p=0.80]. Angina free survival was significantly higher in FFR-guided as compared with Angio-guided group (69% vs. 49%, p = 0.02).
Conclusions. FFR-guided PCI of intermediate stenosis of CABG is safe and results into comparable clinical outcome with angio-guided PCI. This is associated with an improved angina free survival and reduced procedural costs.
- © 2012 by American Heart Association, Inc.