Author + information
- Received March 9, 2018
- Revision received August 31, 2018
- Accepted September 4, 2018
- Published online November 26, 2018.
- Anne Langhoff Thuesen, MDa,∗ (, )@AUHdk,
- Lars Peter Riber, MD, PhDb,
- Karsten Tange Veien, MDa,
- Evald Høj Christiansen, MD, PhDc,
- Svend Eggert Jensen, MD, PhDd,
- Ivy Modrau, MD, DMScie,
- Jan Jesper Andreasen, MD, PhDf,g,
- Anders Junker, MD, PhDa,
- Poul Erik Mortensen, MDb and
- Lisette Okkels Jensen, MD, DMSci, PhDa
- aDepartment of Cardiology, Odense University Hospital, Odense, Denmark
- bDepartment of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
- cDepartment of Cardiology, Aarhus University Hospital, Skejby, Denmark
- dDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- eDepartment of Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Denmark
- fDepartment of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- gDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark
- ↵∗Address for correspondence:
Dr. Anne Langhoff Thuesen, Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
Background The value of fractional flow reserve (FFR) evaluation of coronary artery stenosis in coronary artery bypass grafting (CABG) is uncertain, and stenosis assessments usually rely on visual estimates of lesion severity.
Objectives This randomized clinical trial evaluated graft patency and clinical outcome after FFR-guided CABG versus angiography-guided CABG.
Methods A total of 100 patients referred for CABG were randomly assigned to FFR-guided or angiography-guided CABG. Based on the coronary angiogram, a heart team made a graft plan for all patients, and FFR evaluations were performed. In FFR-guided CABG, coronary lesions with FFR >0.80 were deferred, and a new graft plan was designed accordingly, whereas the surgeon was blinded to the FFR values in patients who underwent angiography-guided CABG. The primary endpoint was graft failure in the percentage of all grafts after 6 months.
Results Angiographic follow-up at 6 months was available for 72 patients (39 vs. 33 in the FFR-guided and angiography-guided groups, respectively). Graft failures of all grafts were similar in both groups (16% vs. 12%; p = 0.97). Rates of death, myocardial infarction, and stroke were also similar in the study groups, and no difference was seen in revascularization before angiographic follow-up. After 6 months, deferred lesions (n = 24) showed a significant reduction in mean FFR from index to follow-up (0.89 ± 0.05 vs. 0.81 ± 0.11; p = 0.002). Index FFR did not influence graft patency.
Conclusions FFR-guided CABG had similar graft failure rates and clinical outcomes as angiography-guided CABG. However, FFR was reduced significantly after 6 months in deferred lesions. (Fractional Flow Reserve Versus Angiography Randomization for Graft Optimization [FARGO]; NCT02477371)
Dr. Thuesen has received a fellowship from the Danish Heart Foundation, the University of Southern Denmark, and the Region of Southern Denmark. Dr. Jensen has received research grants from Biotronik, St. Jude Medical, and Biosensors. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 9, 2018.
- Revision received August 31, 2018.
- Accepted September 4, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.