November 28, 2019
Study Validates FFR-Guided PCI in Patients With Acute Coronary Syndrome
November 29, 2019—Findings from a study evaluating the use of fractional flow reserve (FFR) assessment in acute coronary syndrome (ACS) were published by Jad Omran, MD, et al online ahead of print in Catheterization & Cardiovascular Interventions. The background of the study is that FFR assessment has been validated as an effective tool to guide revascularization of stable coronary artery disease, but its role in ACS is less established.
As summarized in Catheterization & Cardiovascular Interventions, the study population was extracted from the National Readmissions Data 2014 using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM) codes for ACS, percutaneous coronary intervention (PCI), FFR, and periprocedural complications. Study endpoints included all‐cause of in‐hospital mortality, length of index hospital stay (LOS), acute kidney injury (AKI), bleeding, coronary dissection, total number of stents used, stroke, vascular complications (VC), and the total charges of index hospitalization.
The investigators identified a total of 304,548 discharges that had the diagnosis of ACS and were treated invasively within the same index hospitalization (average age, 65.1 years; 64% men).
Among these, 7,832 had FFR-guided invasive treatment (2.6%), which was associated with significantly lower in‐hospital all‐cause mortality (1.1% vs 3.1%; P < .01), shorter LOS (4.6 vs 5.3 days; P < .01), less AKI (12.5% vs 14.6%; P < .01), less bleeding (7% vs 8.5%; P < .01), and lower total charges ($99,805 vs $105,736). There was no significant difference between both groups in terms of stroke (2.2% vs 2.3%; P = .41), coronary dissection (0.7% vs 0.8%; P = .34), VC (1.3% vs 1%; P = .01), or the total number of stents used (55.5% vs 54.5%; P = .34).
In patients presenting with an ACS, FFR‐guided PCI compared to angiography-guided PCI was associated with lower rates of in‐hospital mortality, shorter LOS, less AKI, less bleeding, and lower hospital charges. There was no significant difference in terms of the incidence of stroke, coronary dissection, VC, or the total number of stents used, concluded the investigators in Catheterization & Cardiovascular Interventions.