Flow reserve testing may improve PCI outcomes


NEW YORK (Reuters Health), Jan 15 - Adding fractional flow reserve (FFR) measurements to angiography may improve survival and other outcomes for patients with multivessel coronary artery disease who undergo percutaneous coronary intervention (PCI) with drug-eluting stents, new research indicates.

As reported in the New England Journal of Medicine for January 15, Dr. Nico H. J. Pijls, from Catharina Hospital, Eindhoven in the Netherlands, and colleagues assessed the outcomes of 1,005 patients who were randomized to undergo PCI guided by angiography alone or with FFR assessment.

Stenting of all angiography-indicated lesions was performed in the angiography-only group, whereas only indicated lesions with a FFR of 0.80 or less were stented in the FFR group. The main outcome measure was the composite of death, nonfatal MI, and repeat revascularization at one year.

The average number of indicated lesions per patient was 2.7 and 2.8 in the angiography-only and FFR groups, respectively (p = NS). Despite this finding, the average number of stents per patient was significantly lower in the FFR group: 1.9 versus 2.7 (p < 0.001).

Roughly 18% of patients in the angiography-only group experienced the main end point compared with just 13.2% of patients in the FFR group (p = 0.02). The proportion of patients free from angina at one year, however, was similar in each group, at about 80%.

The results support "the evolving strategy of revascularization of ischemic lesions and medical treatment of nonischemic lesions," the authors state.

In a related editorial, Dr. Stephen G. Ellis, from the Cleveland Clinic, comments that "history has shown us that not all statistically significant results from studies of this size are repeatable. It is likely, however, on the basis of results from other relevant trials ... that the investigators are on to something."

N Engl J Med 2009;360:213-224,292-294.

Last Updated: 2009-01-14 17:30:52 -0400 (Reuters Health)

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