PCI with intracoronary pressure wire guidance lowers risk of mortality, restenosis

The use of fractional flow reserve (FFR) appears to reduce the risk of long-term mortality, stent thrombosis, and restenosis in patients undergoing percutaneous coronary intervention (PCI) for stable angina pectoris, a recent study has shown.

The authors obtained data from the Swedish Coronary Angiography and Angioplasty Registry on all patients undergoing PCI, with or without FFR guidance, for stable angina pectoris between January 2005 and March 2016.

All-cause mortality was the primary endpoint, while secondary ones included stent thrombosis or restenosis and periprocedural complications. Multilevel Cox proportional hazards regression adjusted with Kernel-based propensity score matching was used as the primary model.

A total of 23,860 patients underwent PCI for stable angina pectoris, of whom 3,367 used FFR guidance. Those who underwent PCI with FFR had lower adjusted risk estimates for all-cause mortality (hazard ratio [HR], 0.81, 95 percent confidence interval [CI], 0.73–0.89; p<0.001) and ST and restenosis (HR, 0.74, 95 percent CI, 0.57–0.96; p=0.022) over a median follow-up of 4.7 years (range, 0–11.2 years).

No between-group difference was observed in terms of periprocedural complications (adjusted odds ratio, 0.96, 95 percent CI, 0.77–1.19; p=0.697).

“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,” the authors said.

Intracoronary pressure wire measurement of FFR confers guidance on decision-making during PCI, according to the authors.