Six-Year Follow-Up of Fractional Flow Reserve-Guided Versus Angiography-Guided Coronary Artery Bypass Graft Surgery

BACKGROUND—Fractional flow reserve (FFR)-guided coronary artery bypass graft (CABG) surgery has been associated with lower number of graft anastomoses, lower rate of on-pump surgery, and higher graft patency rate as compared with angiography-guided CABG surgery. However, no clinical benefit has been...

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Published inCirculation. Cardiovascular interventions Vol. 11; no. 6; p. e006368
Main Authors Fournier, Stephane, Toth, Gabor G, De Bruyne, Bernard, Johnson, Nils P, Ciccarelli, Giovanni, Xaplanteris, Panagiotis, Milkas, Anastasios, Strisciuglio, Teresa, Bartunek, Jozef, Vanderheyden, Marc, Wyffels, Eric, Casselman, Filip, Van Praet, Frank, Stockman, Bernard, Degrieck, Ivan, Barbato, Emanuele
Format Journal Article
LanguageEnglish
Published United States American Heart Association, Inc 01.06.2018
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Summary:BACKGROUND—Fractional flow reserve (FFR)-guided coronary artery bypass graft (CABG) surgery has been associated with lower number of graft anastomoses, lower rate of on-pump surgery, and higher graft patency rate as compared with angiography-guided CABG surgery. However, no clinical benefit has been reported to date. METHODS AND RESULTS—Consecutive patients (n=627) treated by CABG between 2006 and 2010 were retrospectively included. In 198 patients, at least 1 stenosis was grafted according to FFR (FFR-guided group), whereas in 429 patients all stenoses were grafted based on angiography (angiography-guided group). The 2 coprimary end points were overall death or myocardial infarction and major adverse cardiovascular events (composite of overall death, myocardial infarction, and target vessel revascularization) up to 6-year follow-up. In the FFR-guided group, patients were significantly younger (66 [57–73] versus 70 [63–76]; P<0.001), more often male (82% versus 72%; P=0.008), and less often diabetic (21% versus 30%; P=0.023). Clinical follow-up (median, 85 [66–104] months) was analyzed in 396 patients after 1:1 propensity-score matching for these 3 variables. The rate of overall death or myocardial infarction was significantly lower in the FFR-guided (n=31 [16%] versus n=49 [25%]; hazard ratio, 0.59 [95% confidence interval, 0.38–0.93]; P=0.020) as compared with the angiography-guided group. Major adverse cardiovascular events rate was also numerically lower in the FFR-guided than in the angiography-guided group (n=42 [21%] versus n=52 [26%]; hazard ratio, 0.77 [95% confidence interval, 0.51–1.16]; P=0.21). CONCLUSIONS—FFR-guided CABG is associated with a significant reduction in the rate of overall death or myocardial infarction at 6-year follow-up as compared with angiography-guided CABG.
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ISSN:1941-7640
1941-7632
DOI:10.1161/CIRCINTERVENTIONS.117.006368