CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

October 28th, 2011

Belgian Study Supports Use of FFR to Guide Therapy in Intermediate LAD Lesions

A study published in JACC: Cardiovascular Interventions suggests that fractional flow reserve (FFR) may be safely used to guide treatment in patients with an intermediate left anterior descending coronary artery (LAD) stenosis.

Olivier Muller and colleagues report on 730 patients at a single center in Belgium who had a 30% to 70% stenosis in the proximal segment of the LAD and received treatment based on FFR. Overall, 564 patients who had an FFR of 0.80 or higher were treated medically, while 166 with an FFR below 0.80 underwent revascularization. In the revascularization group, 13% underwent surgery and 87% had PCI.

Estimated 5-year survival was 92.9% in the medical group and 87.4% in the revascularization group (p=0.03). Estimated 5-year survival free of death, MI, and target vessel revascularization was 89.7% and 68.5%, respectively (p<0.0001).

The authors write that their findings indicate that “patients with an angiographically dubious, but hemodynamically nonsignificant, isolated stenosis in the proximal LAD (as assessed in the catheterization laboratory by FFR measurements) have a favorable long-term outcome without mechanical revascularization.” They note that although current recommendations call for functional testing to demonstrate ischemia prior to revascularization, a number of common factors “in daily practice” mean that this recommendation is frequently overlooked. As an alternative, “FFR makes it possible to obtain both anatomic and functional data during the same examination.”

The study, they conclude, “supports the strategy of deciding about revascularization based on both anatomic and functional information obtained simultaneously in the catheterization laboratory.”

Categories: Cardiac Surgery
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2 Responses to “Belgian Study Supports Use of FFR to Guide Therapy in Intermediate LAD Lesions”

  1. Milan Kostek, MD says:
    October 30, 2011 at 3:30 am

    One of the findings in the study is that 10% of lesions between 30% and 50% were hemodynamically significant. Should this fact make FFR measurement of proximal LAD mandatory? I think those 10% of pts should deserve it (as well as the patients without ischemia proven by FFR). I´ll welcome opinions of experts?

  2. William L Blanchet, MD says:
    October 31, 2011 at 12:02 am

    All that I can conclude from this study is that less revascularization is better… I think. The lesser obstructed medically managed group fared better than the greater obstructed revascularized group.

    Does this study prove anything? I don’t see that it does. If the greater obstructed revascrlarized group was treated medically without stenting, perhaps they would have done better than they did with the stent.

    I fail to see how this is in any way an argument for FFR in any subject other than those who seem stenosed by angiography who might be able to avoid the stent after FFR measurement.

    Competing interests pertaining specifically to this post, comment, or both:
    None