Author + information
- Received July 11, 2019
- Revision received October 2, 2019
- Accepted October 21, 2019
- Published online January 27, 2020.
- Rushi V. Parikh, MDa@rushiparikh11,
- Grace Liu, MScb,
- Mary E. Plomondon, PhDb,
- Thomas S.G. Sehested, MDc,
- Mark A. Hlatky, MDd,
- Stephen W. Waldo, MDb,e@StephenWaldoMD and
- William F. Fearon, MDf,∗ ( )(, )@wfearonmd
- aDivision of Cardiology, University of California, Los Angeles, Los Angeles, California
- bRocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
- cDepartment of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- dDepartment of Health Research and Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California
- eSection of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
- fDivision of Cardiovascular Medicine and Stanford Cardiovascular Institute, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Stanford, California
- ↵∗Address for correspondence:
Dr. William F. Fearon, Division of Cardiovascular Medicine, Veterans Affairs Palo Alto Health Care System and Stanford University, 300 Pasteur Drive, Room H2103, Palo Alto, California 94035.
Background The use and clinical outcomes of fractional flow reserve (FFR) measurement in patients with stable ischemic heart disease (SIHD) are uncertain, as prior studies have been based on selected populations.
Objectives This study sought to evaluate contemporary, real-world patterns of FFR use and its effect on outcomes among unselected patients with SIHD and angiographically intermediate stenoses.
Methods The authors used data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program to analyze patients who underwent coronary angiography between January 1, 2009, and September 30, 2017, and had SIHD with angiographically intermediate disease (40% to 69% diameter stenosis on visual inspection). The authors documented trends in FFR utilization and evaluated predictors using generalized mixed models. They applied Cox proportional hazards models to determine the association between an FFR-guided revascularization strategy and all-cause mortality at 1 year.
Results A total of 17,989 patients at 66 sites were included. The rate of FFR use gradually increased from 14.8% to 18.5% among all patients with intermediate lesions, and from 44% to 75% among patients who underwent percutaneous coronary intervention. One-year mortality was 2.8% in the FFR group and 5.9% in the angiography-only group (p < 0.0001). After adjustment for patient, site-level, and procedural factors, FFR-guided revascularization was associated with a 43% lower risk of mortality at 1 year compared with angiography-only revascularization (hazard ratio: 0.57; 95% confidence interval: 0.45 to 0.71; p < 0.0001).
Conclusions In patients with SIHD and angiographically intermediate stenoses, use of FFR has slowly risen, and was associated with significantly lower 1-year mortality.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government. This material is the result of work supported with resources and the use of facilities at the Rocky Mountain Regional VA Medical Center. Dr. Waldo has received unrelated research funding to the Denver Research Institute from Abiomed, Cardiovascular Systems Inc., and Merck Pharmaceuticals. Dr. Hlatky has received research funding from HeartFlow. Dr. Fearon has received research support from Abbott Vascular and Medtronic; and has minor stock options with HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 11, 2019.
- Revision received October 2, 2019.
- Accepted October 21, 2019.
- 2020 American College of Cardiology Foundation
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