July 11th, 2014
Do FFR and IVUS Feed the Elephant?
In an observational study of all patients who underwent PCI in National Health Service hospitals in London between January 1, 2004, and July 31, 2011 (n = 41,688), fractional flow reserve (FFR)-guided and intravascular ultrasonography (IVUS)-guided PCI were not associated with improved long-term survival when compared with standard angiography-guided PCI (performed on the basis of visual lesion assessment).
In an accompanying editorial, Aseem Malhotra remarks: “The elephant in the room is that randomized studies (including patients at low risk and high risk) have not demonstrated outcomes benefit for stenting stable coronary disease in addition to optimal medical therapy despite its widespread use.”
This follows on the heels of a recent Circulation paper by Hopkins cardiologist, Armin Arbab-Zadeh, who notes that “The rationale for the FFR concept…is based on a common misconception of the relationship between provocable myocardial ischemia and risk of adverse cardiac events.”
JOIN THE DISCUSSION
Does FFR/IVUS guided-PCI prevent MI or death?
Are FFR and IVUS overused or underused?
Do you ever discuss FFR or IVUS with your patients?
Does treating provocable ischemia with PCI prevent MI or death?