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Circ Cardiovasc Interv. 2018 Jun;11(6):e006368. doi: 10.1161/CIRCINTERVENTIONS.117.006368.

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

Author information

1
From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.).
2
Department of Cardiology, Medical University of Graz, Austria (G.G.T.).
3
Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX (N.P.J.).
4
Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (T.S., E.B.).
5
Department of Cardiovascular Surgery (F.C., F.V.P., B.S., I.D.), Cardiovascular Center Aalst OLV Hospital, Belgium.
6
From the Department of Cardiology (S.F., B.D.B., G.C., P.X., A.M., J.B., M.V., E.W., E.B.) emanuele.barbato@olvz-aalst.be.

Abstract

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.

KEYWORDS:

angiography; coronary artery bypass; coronary artery disease; coronary stenosis; fractional flow reserve; myocardial infarction

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