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Survival of Patients With Angina Pectoris Undergoing Percutaneous Coronary Intervention With Intracoronary Pressure Wire Guidance

Völz, Sebastian ; Dworeck, Christian ; Redfors, Björn ; Pétursson, Pétur ; Angerås, Oskar ; Gan, Li Ming ; Götberg, Matthias LU ; Sarno, Giovanna ; Venetsanos, Dimitrios and Grimfärd, Per , et al. (2020) In Journal of the American College of Cardiology 75(22). p.2785-2799
Abstract

Background: Intracoronary pressure wire measurement of fractional flow reserve (FFR) provides decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the effect of FFR on long-term clinical outcomes in patients with stable angina pectoris. Objectives: The purpose of this study was to determine the association between the usage of FFR and all-cause mortality in patients with stable angina undergoing PCI. Methods: Data was used from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) on all patients undergoing PCI (with or without FFR guidance) for stable angina pectoris in Sweden between January 2005 and March 2016. The primary endpoint was all-cause mortality, and the... (More)

Background: Intracoronary pressure wire measurement of fractional flow reserve (FFR) provides decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the effect of FFR on long-term clinical outcomes in patients with stable angina pectoris. Objectives: The purpose of this study was to determine the association between the usage of FFR and all-cause mortality in patients with stable angina undergoing PCI. Methods: Data was used from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) on all patients undergoing PCI (with or without FFR guidance) for stable angina pectoris in Sweden between January 2005 and March 2016. The primary endpoint was all-cause mortality, and the secondary endpoints were stent thrombosis (ST) or restenosis and peri-procedural complications. The primary model was multilevel Cox proportional hazards regression adjusted with Kernel-based propensity score matching. Results: In total, 23,860 patients underwent PCI for stable angina pectoris; of these, FFR guidance was used in 3,367. After a median follow-up of 4.7 years (range 0 to 11.2 years), the FFR group had lower adjusted risk estimates for all-cause mortality (hazard ratio: 0.81; 95% confidence interval [CI]: 0.73 to 0.89; p < 0.001), and ST and restenosis (hazard ratio: 0.74; 95% CI: 0.57 to 0.96; p = 0.022). The number of peri-procedural complications did not differ between the groups (adjusted odds ratio: 0.96; 95% CI: 0.77 to 1.19; p = 0.697). Conclusions: In this observational study, the use of FFR was associated with a lower risk of long-term mortality, ST, and restenosis in patients undergoing PCI for stable angina pectoris. This study supports the current European and American guidelines for the use of FFR during PCI and shows that intracoronary pressure wire guidance confers prognostic benefit in patients with stable angina pectoris.

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published
subject
keywords
coronary artery disease, fractional flow reserve, percutaneous coronary intervention, stable angina pectoris
in
Journal of the American College of Cardiology
volume
75
issue
22
pages
15 pages
publisher
Elsevier USA
external identifiers
  • pmid:32498806
  • scopus:85085049607
ISSN
0735-1097
DOI
10.1016/j.jacc.2020.04.018
language
English
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yes
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96868555-39f2-452f-9980-069a8694d1f4
date added to LUP
2020-06-12 13:25:12
date last changed
2020-07-08 05:17:03
@article{96868555-39f2-452f-9980-069a8694d1f4,
  abstract     = {<p>Background: Intracoronary pressure wire measurement of fractional flow reserve (FFR) provides decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the effect of FFR on long-term clinical outcomes in patients with stable angina pectoris. Objectives: The purpose of this study was to determine the association between the usage of FFR and all-cause mortality in patients with stable angina undergoing PCI. Methods: Data was used from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) on all patients undergoing PCI (with or without FFR guidance) for stable angina pectoris in Sweden between January 2005 and March 2016. The primary endpoint was all-cause mortality, and the secondary endpoints were stent thrombosis (ST) or restenosis and peri-procedural complications. The primary model was multilevel Cox proportional hazards regression adjusted with Kernel-based propensity score matching. Results: In total, 23,860 patients underwent PCI for stable angina pectoris; of these, FFR guidance was used in 3,367. After a median follow-up of 4.7 years (range 0 to 11.2 years), the FFR group had lower adjusted risk estimates for all-cause mortality (hazard ratio: 0.81; 95% confidence interval [CI]: 0.73 to 0.89; p &lt; 0.001), and ST and restenosis (hazard ratio: 0.74; 95% CI: 0.57 to 0.96; p = 0.022). The number of peri-procedural complications did not differ between the groups (adjusted odds ratio: 0.96; 95% CI: 0.77 to 1.19; p = 0.697). Conclusions: In this observational study, the use of FFR was associated with a lower risk of long-term mortality, ST, and restenosis in patients undergoing PCI for stable angina pectoris. This study supports the current European and American guidelines for the use of FFR during PCI and shows that intracoronary pressure wire guidance confers prognostic benefit in patients with stable angina pectoris.</p>},
  author       = {Völz, Sebastian and Dworeck, Christian and Redfors, Björn and Pétursson, Pétur and Angerås, Oskar and Gan, Li Ming and Götberg, Matthias and Sarno, Giovanna and Venetsanos, Dimitrios and Grimfärd, Per and Hofmann, Robin and Jensen, Jens and Björklund, Fredrik and Danielewicz, Mikael and Linder, Rickard and Råmunddal, Truls and Fröbert, Ole and Witt, Nils and James, Stefan and Erlinge, David and Omerovic, Elmir},
  issn         = {0735-1097},
  language     = {eng},
  number       = {22},
  pages        = {2785--2799},
  publisher    = {Elsevier USA},
  series       = {Journal of the American College of Cardiology},
  title        = {Survival of Patients With Angina Pectoris Undergoing Percutaneous Coronary Intervention With Intracoronary Pressure Wire Guidance},
  url          = {http://dx.doi.org/10.1016/j.jacc.2020.04.018},
  doi          = {10.1016/j.jacc.2020.04.018},
  volume       = {75},
  year         = {2020},
}