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Use of fractional flow reserve significantly improved 1-year mortality rates in adults with stable ischemic heart disease, according to a review of 17,989 patients.
Although fractional flow reserve (FFR) has demonstrated value in guiding coronary revascularization, its impact on outcomes in patients with stable ischemic heart disease has not been well studied in a large population, wrote Rushi V. Parikh, MD, of the University of California, Los Angeles, and colleagues.
In a study published in the Journal of the American College of Cardiology, the researchers analyzed data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program for adults who underwent coronary angiography between January 2009 and September 2017. The study included patients with angiographically intermediate disease, defined as 40%-69% diameter stenosis on visual inspection.
The rate of FFR use increased from 14.8% to 18.5% during the study period for all patients with intermediate lesions, and from 44% to 75% for those who had percutaneous coronary intervention, the researchers wrote.
Overall, based on hazard models, 1-year mortality was significantly lower in patients who underwent FFR, compared with those who had angiography only (2.8% vs. 5.9%; P less than 0.001). In addition, FFR use in revascularization was associated with a 43% reduced 1-year mortality risk, compared with angiography only.
The findings were limited by several factors, including the observational nature of the study, inability to distinguish between cardiovascular and noncardiovascular mortality, lack of data on the technical performance of the FFR, and a relatively short follow-up period, the researchers noted.
However, the results were strengthened by the large sample size, and support the use of FFR-guided revascularization in patients with angiographically intermediate stenosis, they wrote.
“Future registry-based studies accounting for all physiologic modalities are warranted to accurately quantify the landscape of coronary physiology-guided revascularization,” they added.
The study was supported in part by the Rocky Mountain Regional VA Medical Center in Aurora, Colo. Lead author Dr. Parikh had no financial conflicts to disclose.
SOURCE: Parikh RV et al. J Am Coll Cardiol. 2020 Feb 4;75:409-19.
Although the study suggests that the use of fractional flow reserve (FFR) has increased, it remains underused despite evidence and recommendations, wrote Julien Adjedj, MD, and Benoit Guillon, MD, in an accompanying editorial (J Am Coll Cardiol. 2020 Feb 4;75:420-1).
“Of course, time, cost, and need for hyperemia are often perceived as stumbling blocks. Yet, the real question is whether the cardiology community – not only interventional cardiologists – has truly adopted FFR (i.e., using it routinely and treating according to the results),” they wrote.
The editorialists noted that, in this study, typical predictors of FFR included younger age, multivessel or left main disease, previous history of percutaneous coronary intervention, no heart failure, and higher left ventricular ejection fraction.
“However, neither the absence of documented ischemia nor the presence of symptoms influenced the use of FFR. Significant site-level variation in FFR was observed,” they wrote. “This important finding suggests that the main reason for FFR underutilization in the contemporary era is operator belief regarding the utility of coronary physiology, and that revised reimbursement policies and additional education/training may not have a meaningful impact on FFR adoption.”
The editorialists emphasized that, although FFR use has increased, the findings of a significant decrease in mortality support additional use of FFR “and good reasons to do so.”
Dr. Adjedj is affiliated with the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, and had no financial conflicts to disclose. Dr. Guillon is affiliated with the University Hospital Jean Minjoz in Besançon, France, and disclosed a grant from Sanofi and participation in a conference for Abbott.
Although the study suggests that the use of fractional flow reserve (FFR) has increased, it remains underused despite evidence and recommendations, wrote Julien Adjedj, MD, and Benoit Guillon, MD, in an accompanying editorial (J Am Coll Cardiol. 2020 Feb 4;75:420-1).
“Of course, time, cost, and need for hyperemia are often perceived as stumbling blocks. Yet, the real question is whether the cardiology community – not only interventional cardiologists – has truly adopted FFR (i.e., using it routinely and treating according to the results),” they wrote.
The editorialists noted that, in this study, typical predictors of FFR included younger age, multivessel or left main disease, previous history of percutaneous coronary intervention, no heart failure, and higher left ventricular ejection fraction.
“However, neither the absence of documented ischemia nor the presence of symptoms influenced the use of FFR. Significant site-level variation in FFR was observed,” they wrote. “This important finding suggests that the main reason for FFR underutilization in the contemporary era is operator belief regarding the utility of coronary physiology, and that revised reimbursement policies and additional education/training may not have a meaningful impact on FFR adoption.”
The editorialists emphasized that, although FFR use has increased, the findings of a significant decrease in mortality support additional use of FFR “and good reasons to do so.”
Dr. Adjedj is affiliated with the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, and had no financial conflicts to disclose. Dr. Guillon is affiliated with the University Hospital Jean Minjoz in Besançon, France, and disclosed a grant from Sanofi and participation in a conference for Abbott.
Although the study suggests that the use of fractional flow reserve (FFR) has increased, it remains underused despite evidence and recommendations, wrote Julien Adjedj, MD, and Benoit Guillon, MD, in an accompanying editorial (J Am Coll Cardiol. 2020 Feb 4;75:420-1).
“Of course, time, cost, and need for hyperemia are often perceived as stumbling blocks. Yet, the real question is whether the cardiology community – not only interventional cardiologists – has truly adopted FFR (i.e., using it routinely and treating according to the results),” they wrote.
The editorialists noted that, in this study, typical predictors of FFR included younger age, multivessel or left main disease, previous history of percutaneous coronary intervention, no heart failure, and higher left ventricular ejection fraction.
“However, neither the absence of documented ischemia nor the presence of symptoms influenced the use of FFR. Significant site-level variation in FFR was observed,” they wrote. “This important finding suggests that the main reason for FFR underutilization in the contemporary era is operator belief regarding the utility of coronary physiology, and that revised reimbursement policies and additional education/training may not have a meaningful impact on FFR adoption.”
The editorialists emphasized that, although FFR use has increased, the findings of a significant decrease in mortality support additional use of FFR “and good reasons to do so.”
Dr. Adjedj is affiliated with the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, and had no financial conflicts to disclose. Dr. Guillon is affiliated with the University Hospital Jean Minjoz in Besançon, France, and disclosed a grant from Sanofi and participation in a conference for Abbott.
Use of fractional flow reserve significantly improved 1-year mortality rates in adults with stable ischemic heart disease, according to a review of 17,989 patients.
Although fractional flow reserve (FFR) has demonstrated value in guiding coronary revascularization, its impact on outcomes in patients with stable ischemic heart disease has not been well studied in a large population, wrote Rushi V. Parikh, MD, of the University of California, Los Angeles, and colleagues.
In a study published in the Journal of the American College of Cardiology, the researchers analyzed data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program for adults who underwent coronary angiography between January 2009 and September 2017. The study included patients with angiographically intermediate disease, defined as 40%-69% diameter stenosis on visual inspection.
The rate of FFR use increased from 14.8% to 18.5% during the study period for all patients with intermediate lesions, and from 44% to 75% for those who had percutaneous coronary intervention, the researchers wrote.
Overall, based on hazard models, 1-year mortality was significantly lower in patients who underwent FFR, compared with those who had angiography only (2.8% vs. 5.9%; P less than 0.001). In addition, FFR use in revascularization was associated with a 43% reduced 1-year mortality risk, compared with angiography only.
The findings were limited by several factors, including the observational nature of the study, inability to distinguish between cardiovascular and noncardiovascular mortality, lack of data on the technical performance of the FFR, and a relatively short follow-up period, the researchers noted.
However, the results were strengthened by the large sample size, and support the use of FFR-guided revascularization in patients with angiographically intermediate stenosis, they wrote.
“Future registry-based studies accounting for all physiologic modalities are warranted to accurately quantify the landscape of coronary physiology-guided revascularization,” they added.
The study was supported in part by the Rocky Mountain Regional VA Medical Center in Aurora, Colo. Lead author Dr. Parikh had no financial conflicts to disclose.
SOURCE: Parikh RV et al. J Am Coll Cardiol. 2020 Feb 4;75:409-19.
Use of fractional flow reserve significantly improved 1-year mortality rates in adults with stable ischemic heart disease, according to a review of 17,989 patients.
Although fractional flow reserve (FFR) has demonstrated value in guiding coronary revascularization, its impact on outcomes in patients with stable ischemic heart disease has not been well studied in a large population, wrote Rushi V. Parikh, MD, of the University of California, Los Angeles, and colleagues.
In a study published in the Journal of the American College of Cardiology, the researchers analyzed data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program for adults who underwent coronary angiography between January 2009 and September 2017. The study included patients with angiographically intermediate disease, defined as 40%-69% diameter stenosis on visual inspection.
The rate of FFR use increased from 14.8% to 18.5% during the study period for all patients with intermediate lesions, and from 44% to 75% for those who had percutaneous coronary intervention, the researchers wrote.
Overall, based on hazard models, 1-year mortality was significantly lower in patients who underwent FFR, compared with those who had angiography only (2.8% vs. 5.9%; P less than 0.001). In addition, FFR use in revascularization was associated with a 43% reduced 1-year mortality risk, compared with angiography only.
The findings were limited by several factors, including the observational nature of the study, inability to distinguish between cardiovascular and noncardiovascular mortality, lack of data on the technical performance of the FFR, and a relatively short follow-up period, the researchers noted.
However, the results were strengthened by the large sample size, and support the use of FFR-guided revascularization in patients with angiographically intermediate stenosis, they wrote.
“Future registry-based studies accounting for all physiologic modalities are warranted to accurately quantify the landscape of coronary physiology-guided revascularization,” they added.
The study was supported in part by the Rocky Mountain Regional VA Medical Center in Aurora, Colo. Lead author Dr. Parikh had no financial conflicts to disclose.
SOURCE: Parikh RV et al. J Am Coll Cardiol. 2020 Feb 4;75:409-19.
FROM THE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Key clinical point: Use of fractional flow reserve to assist in revascularization significantly reduced the 1-year mortality risk in patients with stable ischemic heart disease.
Major finding:
Study details: The data come from a review of 17,989 patients who underwent coronary angiography during 2009-2017.
Disclosures: The study was supported in part by the Rocky Mountain Regional Veterans Affairs Medical Center in Aurora, Colo. Lead author Dr. Parikh had no financial conflicts to disclose.
Source: Parikh RV et al. J Am Coll Cardiol. 2020 Feb 4;75:409-19.