Clinical impact of FFR-guided PCI compared to angio-guided PCI from the France PCI registry

Catheter Cardiovasc Interv. 2022 Jul;100(1):40-48. doi: 10.1002/ccd.30225. Epub 2022 May 11.

Abstract

Objectives: We sought to compare, in a national French registry (FrancePCI), the clinical impact of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with angio-guided PCI at 1 year.

Background: FFR has become the invasive gold standard to quantify myocardial ischemia generated by a coronary stenosis in patients with chronic coronary syndrome, but in clinical practice it is still underutilised to guide PCI compared to angiography (angio).

Methods: We extracted from the FrancePCI database all chronic coronary syndrome patients treated with PCI for coronary stenosis <90% between 2014 and 2019. Our composite clinical endpoint was the rate of major adverse clinical events (MACE).

Results: Fourteen thousand three hundred eighty-four patients with 1-year clinical follow-up were included. Among them, 13,125 had angio-guided PCI (91%) and 1259 (9%) had FFR-guided PCI. We observed a significantly higher rate of MACE in the angio-guided group versus the FFR-guided group: 1478 (11.3%) versus 100 (7.9%) (p < 0.0001), respectively, with hazard ratio (HR) of 1.440, 95% confidence interval (CI) [1.211-1.713] (p = 0.0004). This result was driven by the higher occurrence of death in the angio-guided group versus the FFR-guided-group: 506 (3.9%) versus 17 (1.4%) (p < 0.0001), respectively, with HR of 2.845, 95% CI [2.099-3.856] (p < 0.0001). After adjustment for potential confounding factors, HRs were 1.287, 95% CI [1.028-1.613] (p = 0.028) for MACE and 2.527, 95% CI [1.452-4.399] (p = 0.001) for death. No significant differences between angio-guided PCI and FFR-guided PCI were observed for other clinical endpoints.

Conclusions: FFR-guided PCI improves outcome at 1 year compared to angio-guided PCI with a reduction of 64% of death.

Keywords: chronic coronary syndrome; clinical outcome; fractional flow reserve.

MeSH terms

  • Coronary Angiography
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / etiology
  • Coronary Artery Disease* / therapy
  • Coronary Stenosis* / diagnostic imaging
  • Coronary Stenosis* / etiology
  • Coronary Stenosis* / therapy
  • Fractional Flow Reserve, Myocardial*
  • Humans
  • Percutaneous Coronary Intervention* / adverse effects
  • Registries
  • Treatment Outcome