Objectives
To determine if fractional flow reserve guided percutaneous coronary intervention (FFR‐guided PCI) is associated with reduced ischemic myocardium compared with angiography‐guided PCI.
Background
Although FFR‐guided PCI has been shown to improve outcomes, it remains unclear if it reduces the extent of ischemic myocardium at risk compared with angiography‐guided PCI.
Methods
We evaluated 380 patients (190 FFR‐guided PCI cases and 190 propensity‐matched controls) who underwent PCI from 2009 to 2014. Clinical, laboratory, angiographic, stress testing, and major adverse cardiac events [MACE] (all‐cause mortality, recurrence of MI requiring PCI, stroke) data were collected.
Results
Mean age was 63 ± 11 years; the majority of patients were males (76%) and Caucasian (77%). Median duration of follow up was 3.4 [Range: 1.9, 5.0] years. Procedural complications including coronary dissection (2% vs. 0%, P = .12) and perforation (0% vs. 0%, P = 1.00) were similar between FFR‐guided and angiography‐guided PCI patients. FFR‐guided PCI patients had lower unadjusted (14.7% vs. 23.2%, P = .04) and adjusted [OR = 0.58 (95% CI: 0.34–0.98)] risk of repeat revascularization at one year. FFR‐guided PCI patients were less likely (23% vs. 32%, P = .02) to have ischemia and had lower (5.9% vs. 21.1%, P < .001) ischemic burden (moderate‐severe ischemia) on post‐PCI stress testing. Presence of ischemia post‐PCI remained a strong predictor of MACE [OR = 2.14 (95%CI: 1.28–3.60)] with worse survival compared to those without ischemia (HR = 1.63 (95% CI: 1.06–2.51).
Conclusion
Compared with angiography‐guided PCI, FFR‐guided PCI results in less repeat revascularization and a lower incidence of post PCI ischemia translating into improved survival, without an increase in complications.