Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation, 146(9), 687–698. https://doi.org/10.1161/CIRCULATIONAHA.121.057793 Dr. Rodney Stables et al
Points
- The RIPCORD trial was carried out to check the efficacy and safety of using the FFR systematic strategy as a potential target for revascularization.
- The trial results indicate that the systematic strategy of FFR for revascularization is not so beneficial over angiography-guided management for patients undergoing coronary angiography for NSTEMI or stable ischemic heart disease.
- FFR strategy is more expensive and time taking than angiographic management.
Summary
A trial study was carried out to check the efficacy and safety of routine systematic measurement of fractional flow reserve (FFR) for all vessels with the caliber of revascularization. For this purpose, 1100 patients were selected in a 1:1 ratio fashion, in which there were 548 patients in the FFR-guided revascularization group and 548 patients in the angiography-guided management group. Patients with mean age 64.3years having stable angina, non–ST-segment elevation myocardial infarction (NSTEMI), angiographic disease, acute coronary syndrome, or ejection fraction were included. In the FFR arm, the measurement of FFR was performed in all arteries with the sufficient caliber of bypass graft conduit or percutaneous coronary intervention. FFR lower than or equal to 0.80 was considered positive.
The results indicated that the systematic FFR strategy (£4510) is more expensive than angiography-guided management (£4136). FFR strategy takes more procedural time (69mint.) than angiographic management (42.2mint.). It also has no superior results in order to enhance the quality of life at 1 year for patients undergoing angiographic treatment for NSTEMI or stable ischemic heart disease.
For FAME 1 and FAME 2, the trial was differently designed, in which FFR was followed by lesions with >50% epicardial stenosis through angiographic assessment, and results indicated benefit in favor of FFR. Additionally, PCI use was also lower in the FFR arm in the prior trial, but it was not noted for the current trial.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057793
References Stables, R. H., Mullen, L. J., Elguindy, M., Nicholas, Z., Aboul-Enien, Y. H., Kemp, I., O’Kane, P., Hobson, A., Johnson, T. W., Khan, S. Q., Wheatcroft, S. B., Garg, S., Zaman, A. G., Mamas, M. A., Nolan, J., Jadhav, S., Berry, C., Watkins, S., Hildick-Smith, D., … Curzen, N. (2022). Routine pressure wire assessment versus conventional angiography in the management of patients with coronary artery disease: The RIPCORD 2 trial. Circulation, 146(9), 687–698. https://doi.org/10.1161/CIRCULATIONAHA.121.057793
