Author + information
- Received January 24, 2020
- Revision received April 3, 2020
- Accepted April 7, 2020
- Published online June 1, 2020.
- Sebastian Völz, MD, PhDa,
- Christian Dworeck, MD, PhDa,
- Björn Redfors, MD, PhDa,
- Pétur Pétursson, MD, PhDa,
- Oskar Angerås, MD, PhDa,
- Li-Ming Gan, MD, PhDa,b,
- Matthias Götberg, MD, PhDc,
- Giovanna Sarno, MD, PhDd,
- Dimitrios Venetsanos, MD, PhDe,
- Per Grimfärd, MD, PhDf,
- Robin Hofmann, MD, PhDg,
- Jens Jensen, MD, PhDg,h,
- Fredrik Björklund, MD, PhDi,
- Mikael Danielewicz, MD, PhDj,
- Rickard Linder, MD, PhDk,
- Truls Råmunddal, MD, PhDa,
- Ole Fröbert, MD, PhDl,
- Nils Witt, MD, PhDg,
- Stefan James, MD, PhDd,
- David Erlinge, MD, PhDc and
- Elmir Omerovic, MD, PhDa,∗ (, )@ElmirOmerovic2
- aDepartment of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
- bEarly Clinical Development, Early CardioVascular, Renal and Metabolism, R&D BioPharmaceuticals, AstraZeneca, Gothenburg, Sweden
- cDepartment of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- dDepartment of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- eDepartment of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- fDepartment of Internal Medicine, Västmanlands Sjukhus, Västerås, Sweden
- gDepartment of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- hUnit of Cardiology, Capio St. Görans Sjukhus, Stockholm, Sweden
- iDepartment of Cardiology, Östersund Hospital, Östersund, Sweden
- jDepartment of Cardiology, PCI-Unit at Karlstad Hospital, Karlstad, Sweden
- kDepartment of Cardiology, Danderyd Hospital, Stockholm, Sweden
- lDepartment of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
- ↵∗Address for correspondence:
Dr. Elmir Omerovic, Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at Gothenburg University, Bruna stråket 14, 413 45, Gothenburg, Sweden.
Background Intracoronary pressure wire measurement of fractional flow reserve (FFR) provides decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the effect of FFR on long-term clinical outcomes in patients with stable angina pectoris.
Objectives The purpose of this study was to determine the association between the usage of FFR and all-cause mortality in patients with stable angina undergoing PCI.
Methods Data was used from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) on all patients undergoing PCI (with or without FFR guidance) for stable angina pectoris in Sweden between January 2005 and March 2016. The primary endpoint was all-cause mortality, and the secondary endpoints were stent thrombosis (ST) or restenosis and peri-procedural complications. The primary model was multilevel Cox proportional hazards regression adjusted with Kernel-based propensity score matching.
Results In total, 23,860 patients underwent PCI for stable angina pectoris; of these, FFR guidance was used in 3,367. After a median follow-up of 4.7 years (range 0 to 11.2 years), the FFR group had lower adjusted risk estimates for all-cause mortality (hazard ratio: 0.81; 95% confidence interval [CI]: 0.73 to 0.89; p < 0.001), and ST and restenosis (hazard ratio: 0.74; 95% CI: 0.57 to 0.96; p = 0.022). The number of peri-procedural complications did not differ between the groups (adjusted odds ratio: 0.96; 95% CI: 0.77 to 1.19; p = 0.697).
Conclusions In this observational study, the use of FFR was associated with a lower risk of long-term mortality, ST, and restenosis in patients undergoing PCI for stable angina pectoris. This study supports the current European and American guidelines for the use of FFR during PCI and shows that intracoronary pressure wire guidance confers prognostic benefit in patients with stable angina pectoris.
- coronary artery disease
- fractional flow reserve
- percutaneous coronary intervention
- stable angina pectoris
This work was supported by the Swedish Heart-Lung Foundation, the Swedish Research Council and ALF Göteborg. Dr. Angerås has received speaker fees from Abbott and Boston Scientific. Dr. Gan is an employee of AstraZeneca. Dr. Fröbert has received an unrestricted grant from Sanofi Pasteur. Dr. James has received institutional research grants from Boston Scientific, Abbott, Medtronic, and Biotronik. Dr. Omerovic has received institutional research grants from AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received January 24, 2020.
- Revision received April 3, 2020.
- Accepted April 7, 2020.
- 2020 American College of Cardiology Foundation
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