Author + information
- Ayoub El Hammiri1,
- Alexis Matteau2,
- Brian Potter3,
- Francois Gobeil3,
- Nicolas Noiseux4,
- Louis-Mathieux Stevens5 and
- Samer Mansour6
- 1Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
- 2Centre hospitalier de l'université de Montréal, Montreal, Quebec, Canada
- 3CHUM, Montreal, Quebec, Canada
- 4Montreal Heart Institute, Montreal, Quebec, Canada
- 5Departement de Chirurgie Cardiaque, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- 6Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
Fraction Flow Reserve (FFR) is currently validated as an important tool in the hemodynamic evaluation of coronary stenosis allowing more accurate identification of significant lesions and resulting in better outcomes. Some studies reported that Coronary Artery Bypass Graft (CABG) on negative FFR arteries might result in early graft failure. The interpretation of hemodynamic and/or angiographical data on lesions may be differently analyzed by interventional cardiologists and cardiac surgeons. Therefore we aim to evaluate the appropriateness of CABG implantation by cardiac surgeons based on FFR evaluation of coronary lesions.
All patients having FFR evaluation of coronary lesion referred for CABG were screened over one year in an academic Canadian tertiary center. Coronary lesions assessed by FFR were classified in two groups: Appropriate CABG or Inappropriate CABG. Inappropriateness was defined as negative FFR resulting in CABG or positive FFR without CABG.
FFR assessment was performed on 108 stenosis in 83 patients referred for CABG surgery. The mean age was 65 ±10 years. Patients were males in 74%, hypertensive 70% and diabetics in 44%. The clinical presentation was Non ST-Elevation Myocardial Infarction in 31% and stable angina in 34% of cases. Total number of CABG 78 (72%) and Inappropriate CABG was recorded in 16%. The inappropriate CABG was more frequent on lesions with negative FFR as compared to lesion with positive FFR (50% vs. 4% respectively; p < 0,0001). Lesions with inappropriate CABG and negative FFR had a trend to be more severe as compared to ungrafted lesions (52% vs 47% respectively; p=0,08).
To our knowledge this is the first report addressing the integration of FFR results by cardiac surgeons in patients referred for CABG surgery. Inappropriate CABG occurred mainly in patients with negative FFR. The impact on adverse clinical events needs to be assessed in large clinical trials.
IMAGING: FFR and Physiologic Lesion Assessment