The British Heart Foundation Fractional Flow Reserve versus Angiography in Guiding Management to Optimise Outcomes in Non-ST-Segment Elevation Myocardial Infarction

Aim

We assessed the management and outcomes of non-ST segment elevation myocardial infarction (NSTEMI) patients randomly assigned to fractional flow reserve (FFR)-guided management or angiography-guided standard care.

Methods and Results

We conducted a prospective, multicentre, parallel group, 1:1 randomised, controlled trial in 350 NSTEMI patients with ≥1 coronary stenosis ≥30% of the lumen diameter assessed visually (threshold for FFR measurement) (NCT01764334) (Figure 1, Table 1). Enrolment took place in 6 UK hospitals from October 2011 – May 2013. FFR was disclosed to the operator in the FFR guided-group (n=176). FFR was measured but not disclosed in the angiography-guided group (n=174). FFR ≤0.80 was an indication for revascularisation by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG).

The median (IQR) time from the index episode of myocardial ischaemia to angiography was 3 (2, 5) days. For the primary outcome, the proportion of patients treated initially by medical therapy was higher in the FFR-guided group than in the angiography-guided group (40 (22.7%) vs. 23 (13.2%), difference 9•5% (95% CI 1.4%, 17.7%), p=0.022). FFR disclosure resulted in a change in treatment between medical therapy, PCI or CABG in 38 (21.6%) patients (Figures 2 & 3). At 12 months, revascularisation remained lower in the FFR-guided group (79.0% vs. 86.8%, difference 7.8% (-0.2%, 15.8%), p=0.054). There were no statistically significant differences in health outcomes and quality of life between the groups (Figure 4).

Conclusion

In NSTEMI patients, angiography-guided management was associated with higher rates of coronary revascularisation compared with FFR-guided management. A larger trial is necessary to assess health outcomes and cost effectiveness.

Source: www.escardio.org