Original Investigation
Utilization and Outcomes of Measuring Fractional Flow Reserve in Patients With Stable Ischemic Heart Disease

https://doi.org/10.1016/j.jacc.2019.10.060Get rights and content
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Abstract

Background

The use and clinical outcomes of fractional flow reserve (FFR) measurement in patients with stable ischemic heart disease (SIHD) are uncertain, as prior studies have been based on selected populations.

Objectives

This study sought to evaluate contemporary, real-world patterns of FFR use and its effect on outcomes among unselected patients with SIHD and angiographically intermediate stenoses.

Methods

The authors used data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program to analyze patients who underwent coronary angiography between January 1, 2009, and September 30, 2017, and had SIHD with angiographically intermediate disease (40% to 69% diameter stenosis on visual inspection). The authors documented trends in FFR utilization and evaluated predictors using generalized mixed models. They applied Cox proportional hazards models to determine the association between an FFR-guided revascularization strategy and all-cause mortality at 1 year.

Results

A total of 17,989 patients at 66 sites were included. The rate of FFR use gradually increased from 14.8% to 18.5% among all patients with intermediate lesions, and from 44% to 75% among patients who underwent percutaneous coronary intervention. One-year mortality was 2.8% in the FFR group and 5.9% in the angiography-only group (p < 0.0001). After adjustment for patient, site-level, and procedural factors, FFR-guided revascularization was associated with a 43% lower risk of mortality at 1 year compared with angiography-only revascularization (hazard ratio: 0.57; 95% confidence interval: 0.45 to 0.71; p < 0.0001).

Conclusions

In patients with SIHD and angiographically intermediate stenoses, use of FFR has slowly risen, and was associated with significantly lower 1-year mortality.

Key Words

fractional flow reserve
mortality
outcomes
stable ischemic heart disease

Abbreviations and Acronyms

ACS
acute coronary syndrome
CAD
coronary artery disease
CI
confidence interval
FFR
fractional flow reserve
HR
hazard ratio
NCDR
National Cardiovascular Data Registry
OR
odds ratio
PCI
percutaneous coronary intervention
SIHD
stable ischemic heart disease
VA CART
Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

Cited by (0)

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government. This material is the result of work supported with resources and the use of facilities at the Rocky Mountain Regional VA Medical Center. Dr. Waldo has received unrelated research funding to the Denver Research Institute from Abiomed, Cardiovascular Systems Inc., and Merck Pharmaceuticals. Dr. Hlatky has received research funding from HeartFlow. Dr. Fearon has received research support from Abbott Vascular and Medtronic; and has minor stock options with HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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