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Measuring fractional flow reserve (FFR) to direct percutaneous coronary stenting in patients with intermediate stenoses or multivessel coronary artery disease reduces composite mortality and morbidity, as well as cost. We investigated the use of this technology among interventionalists, comparing operator age, practice setting (university vs community), and angiogram volume to understand differences in and reasons for the utilization of FFR.
An electronic survey study of 1,089 interventionalists was performed from 2/2/2012 to 3/6/2012. There were 255 responses to questions regarding demographics and FFR utilization, including reasons for using and not using FFR, FFR threshold values, number of FFR-deferred revascularizations, reclassifications of coronary anatomy, non-coronary use of FFR, changes in FFR use, and tools used to guide the decision to stent.
The majority of respondents were older than 45 years (58%), worked primarily in a community hospital (59%), and performed 10-30 cases per month (52%; 18% performed <10, and 30% performed >30). More than half (145/253, 57%) used FFR in fewer than one third of cases, and 39/253 (15%) never used FFR. There were no differences in use of FFR by age, practice location, or angiogram volume (p=ns for all). With 72% of operators using an FFR cutoff of 0.8 and 28% using 0.75, revascularization was deferred more than half the time by 40% of operators, and anatomy was downgraded from multivessel disease more than half the time by 19% of operators. Respondents used FFR more frequently than intravascular ultrasound (72% vs 60%) to help guide the decision to stent (p<0.01). The primary reasons operators reported not using FFR were lack of availability (47%) and issues with reimbursement (39%).
This first survey of interventionalists shows no difference in FFR utilization by age, practice setting, or case volume. FFR was the preferred adjunctive tool in guiding decisions to stent, defer revascularization, and downgrade multivessel CAD severity. Problems with availability and reimbursement appear to impede wider utilization.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: When to Intervene or Not in Stable Ischemic Heart Disease
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1195M-72
- 2013 American College of Cardiology Foundation