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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.

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



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.


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).


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.


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

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