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Impact of Routine Fractional Flow Reserve Evaluation During Coronary Angiography on Management Strategy and Clinical Outcome: One-Year Results of the POST-IT Multicenter Registry

2016Journal article Open access
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dc.contributor.authorBaptista, SB
dc.contributor.authorRaposo, L
dc.contributor.authorSantos, L
dc.contributor.authorRamos, R
dc.contributor.authorCalé, R
dc.contributor.authorJorge, E
dc.contributor.authorMachado, C
dc.contributor.authorCosta, M
dc.contributor.authorOliveira, E
dc.contributor.authorCosta, J
dc.contributor.authorPipa, J
dc.contributor.authorFonseca, N
dc.contributor.authorGuardado, J
dc.contributor.authorSilva, B
dc.contributor.authorSousa, MJ
dc.contributor.authorSilva, JC
dc.contributor.authorRodrigues, A
dc.contributor.authorSeca, L
dc.contributor.authorFernandes, R
dc.date.accessioned2016-10-12T15:14:10Z
dc.date.available2016-10-12T15:14:10Z
dc.date.issued2016
dc.description.abstractPenetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome. METHODS AND RESULTS: Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry. FFR-driven change in management strategy (medical therapy, revascularization, or additional stress imaging) was assessed per-lesion and per-patient, and the agreement between final and initial strategies was recorded. Cardiovascular death, myocardial infarction, or unplanned revascularization (MACE) at 1 year was recorded. A total of 1293 lesions were evaluated in 918 patients (mean FFR, 0.81±0.1). Management plan changed in 406 patients (44.2%) and 584 lesions (45.2%). One-year MACE was 6.9%; patients in whom all lesions were deferred had a lower MACE rate (5.3%) than those with at least 1 lesion revascularized (7.3%) or left untreated despite FFR≤0.80 (13.6%; log-rank P=0.014). At the lesion level, deferral of those with an FFR≤0.80 was associated with a 3.1-fold increase in the hazard of cardiovascular death/myocardial infarction/target lesion revascularization (P=0.012). Independent predictors of target lesion revascularization in the deferred lesions were proximal location of the lesion, B2/C type and FFR. CONCLUSIONS: Routine FFR assessment of coronary lesions safely changes management strategy in almost half of the cases. Also, it accurately identifies patients and lesions with a low likelihood of events, in which revascularization can be safely deferred, as opposed to those at high risk when ischemic lesions are left untreated, thus confirming results from randomized trials.pt_PT
dc.identifier.citationCirc Cardiovasc Interv. 2016 Jul;9(7). pii: e003288.pt_PT
dc.identifier.doi10.1161/CIRCINTERVENTIONS.115.003288.pt_PT
dc.identifier.issn1941-7632
dc.identifier.urihttp://hdl.handle.net/10400.10/1733
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherAmerican Heart Associationpt_PT
dc.relation.publisherversionhttp://circinterventions.ahajournals.org/content/9/7/e003288.full.pdf+htmlpt_PT
dc.subjectCoronary angiographypt_PT
dc.subjectAngiografia coronáriapt_PT
dc.titleImpact of Routine Fractional Flow Reserve Evaluation During Coronary Angiography on Management Strategy and Clinical Outcome: One-Year Results of the POST-IT Multicenter Registrypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceHagerstownpt_PT
oaire.citation.titleCirculation. Cardiovascular interventions.pt_PT
oaire.citation.volume9pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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