Fractional Flow Reserve-Guided Versus Angiography-Guided Coronary Artery Bypass Graft Surgery
Background—Fractional Flow Reserve (FFR) is well established for patients (pts) undergoing percutaneous coronary intervention, yet little is known for candidates to coronary artery bypass graft surgery (CABG).
Methods and Results—From 2006 to 2010, we retrospectively included in this registry 627 consecutive pts treated by CABG having at least one angiographically intermediate stenosis. In 429 pts, CABG was solely based on angiography (Angio-guided group). In 198 pts, at least one intermediate stenosis was grafted with FFR ≤ 0.80 or deferred with FFR > 0.80 (FFR-guided group). Endpoint was major adverse cardiovascular events (MACE) at 3 years, defined as the composite of overall death, myocardial infarction and target vessel revascularization. Rate of angiographic multivessel disease was similar in Angio-guided group vs. FFR-guided group (404 [94.2%] vs. 186 [93.9%], p=0.722). In FFR-guided group, this was significantly down-graded after FFR measurements to 86.4% (p<0.001 vs. before FFR), and it was associated with lower number of anastomoses (3[2-3] vs. 3 [2-4], p<0.001) and rate of on-pump surgery (49% vs. 69%, p<0.001). At 3 years, MACE was not different between Angio-guided and FFR-guided group (12% vs. 11%, HR: 1.030, 95% CI: 0.627 to 1.692, p=0.908). Yet, FFR-guided group compared with Angio-guided group presented significantly lower rate of angina (CCS class II-IV: 31% vs. 47%, p<0.001).
Conclusions—FFR-guided CABG was associated with lower number of graft anastomoses and rate of on-pump surgery as compared with Angio-guided CABG. This did not result into a higher event rate up to 36-month follow-up and was associated with lower rate of angina.
- Received March 22, 2013.
- Revision received July 3, 2013.
- Accepted July 30, 2013.