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.”