Author + information
- Received April 11, 2002
- Revision received September 13, 2002
- Accepted October 31, 2002
- Published online April 2, 2003.
- Massoud A Leesar, MD, FACC*,* (, )
- Talal Abdul-Baki, MD*,
- Nuri I Akkus, MD*,
- Anil Sharma, MD, FACC*,
- Tarif Kannan, MD* and
- Roberto Bolli, MD, FACC*
- ↵*Reprint requests and correspondence:
Dr. Massoud A. Leesar, Division of Cardiology, University of Louisville, Louisville, Kentucky 40292, USA.
Presented at the 50th Annual Scientific Session of the American College of Cardiology in Orlando, Florida, in March 2001.
Objectives The present study sought to determine the value of fractional flow reserve (FFR) compared with stress perfusion scintigraphy (SPS) in patients with recent unstable angina/non–ST-segment elevation myocardial infarction (UA/NSTEMI).
Background Fractional flow reserve, an invasive index of stenosis severity, is a reliable surrogate for SPS in patients with normal left ventricular function. An FFR ≥0.75 can distinguish patients after myocardial infarction (MI) with a positive SPS from those with a negative SPS. However, the use of FFR has not been investigated after UA/NSTEMI.
Methods Seventy patients who had recent UA/NSTEMI and an intermediate single-vessel stenosis were randomized to either SPS (n = 35) or FFR (n = 35). Patients in the SPS group were discharged if the SPS revealed no ischemia, whereas those in the FFR group were discharged if the FFR was ≥0.75. Patients with a positive SPS and those with an FFR <0.75 underwent percutaneous transluminal coronary angioplasty.
Results The use of FFR markedly reduced the duration and cost of hospitalization compared with SPS (11 ± 2 h vs. 49 ± 5 h [−77%], p < 0.001; and $1,329 ± $44 vs. $2,113 ± $120, respectively, p < 0.05). There were no significant differences in procedure time, radiation exposure time, or event rates during follow-up, including death, MI, or revascularization.
Conclusions These data indicate that: 1) the use of FFR in patients with recent UA/NSTEMI markedly reduces the duration and cost of hospitalization compared with SPS; and 2) these benefits are not associated with an increase in procedure time, radiation exposure time, or clinical event rates.
- Received April 11, 2002.
- Revision received September 13, 2002.
- Accepted October 31, 2002.
- American College of Cardiology Foundation