Application and comparison of fractional flow reserve and angiography for guiding percutaneous coronary intervention in patients with stable coronary artery disease

Objectives To explore the role of fractional flow reserve(FFR) in guiding percutaneous coronary intervention(PCI) in patients with stable coronary artery disease. Methods The study included 293 patients with 703 coronary artery lesions. They were randomly assigned to FFR-guided PCI group(n =147) and coronary angiography(CAG)-guided PCI group(n =146). The primary endpoint was a composite of death, myocardial infarction and ischemia-driven target vessel revascularization 1 year after index procedure. Results The lesions underwent revascularization therapy in FFR group were significantly less than CAG group(41.0% vs. 50.6%, P =0.011). Less contrast agent was used in FFR group than in CAG group [(104±31) m L vs.(111±28) m L, P =0.047 ]. Average cost was lower in FFR group than in CAG group [(3.16±1.42) ten thousand Yuan vs.(3.88±1.73) ten thousand Yuan, P0.001 ]. More patients were free from angina or had very slight angina in FFR group than in CAG group(83.7% vs.73.3%, P =0.03). No significant difference was found in major adverse cardiac event rates between the two groups(2.0% vs. 3.5%, P =0.501). Conclusions Compared with CAG, routine measurement of FFR in patients with stable coronary artery disease can reduce the number of stent implanted and improve angina with a better outcome, without increasing the major adverse cardiac event incidence.