AIMS: In the randomized GRAFFITI trial, surgeons drew their strategy based on coronary angiography. When patients were randomized to fractional flow reserve (FFR)-guidance, surgeons were informed of the FFR values and asked to redraw their strategy. The aim of this study was to investigate the changes induced by FFR knowledge. METHODS AND RESULTS: The intended and performed strategy (before and after FFR) were compared. Among 172 patients, 84 with 300 lesions were randomized to the FFR-guided group. The intended strategy was to bypass 236 stenoses:108 with a venous and 128 with an arterial graft. After disclosing FFR, a change in strategy occurred in 64 lesions (21.3%) of 48 (55%) patients. Among 64 lesions for which the intended strategy was medical therapy, 16 (25%) were bypassed after disclosing FFR. The number of procedures with >1 venous graft planned was significantly reduced from 37 to 27 patients (p = .031). The proportion of on-pump surgery was significantly reduced from 71 to 61 patients (p = .006). The rates of clinical events at 1 year were similar between patients with or without at least one change in strategy. DISCUSSION: FFR-guided CABG is associated with a simplified surgical procedure in 55% of the patients, with similar clinical outcomes.

Cardiovascular Center Na Homolce Hospital Prague Czech Republic

Cardiovascular Research Center Aalst OLV Clinic Aalst Belgium

Department of Advanced Biomedical Sciences Federico 2 University Naples Italy

Department of Cardiology and Internal Medicine University Hospital Brno and Medical Faculty of Masaryk University Brno Czech Republic

Department of Cardiology Hospital Santa Marta Centro Hospitalar Lisboa Central Lisbon Portugal

Department of Cardiology Hungarian Institute of Cardiology Budapest Hungary

Department of Cardiology Lausanne University Center Hospital Lausanne Switzerland

Division of Cardiology Department of Medicine University of Verona Verona Italy

University Heart Center Graz Department of Cardiology Medical University Graz Graz Austria

Zobrazit více v PubMed

Task Force M, Montalescot G, Sechtem U, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949-3003.

Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease: a report of the American College of Cardiology Appropriate use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2017;69:2212-2241.

Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER study. J Am Coll Cardiol. 2007;49:2105-2111.

De Bruyne B, Fearon WF, Pijls NH, et al. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med. 2014;371:1208-1217.

De Bruyne B, Pijls NH, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367:991-1001.

Puymirat E, Peace A, Mangiacapra F, et al. Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary revascularization in patients with small-vessel disease. Circ Cardiovasc Interv. 2012;5:62-68.

Muller O, Mangiacapra F, Ntalianis A, et al. Long-term follow-up after fractional flow reserve-guided treatment strategy in patients with an isolated proximal left anterior descending coronary artery stenosis. JACC Cardiovasc Interv. 2011;4:1175-1182.

Hamilos M, Muller O, Cuisset T, et al. Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation. 2009;120:1505-1512.

Xaplanteris P, Fournier S, Pijls NHJ, et al. Five-year outcomes with PCI guided by fractional flow reserve. N Engl J Med. 2018;379:250-259.

Ahmadi A, Stanger D, Puskas J, Taggart D, Chandrashekhar Y, Narula J. Is there a role for fractional flow reserve in coronary artery bypass graft (CABG) planning? Ann Cardiothorac Surg. 2018;7:546-551.

Toth GG, De Bruyne B, Kala P, et al. Graft patency after FFR-guided versus angiography-guided coronary artery bypass grafting. The GRAFFITI trial. EuroIntervention. 2019;15:00463.

Fournier S, Toth GG, De Bruyne B, et al. Six-year follow-up of fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery. Circ Cardiovasc Interv. 2018;11:e006368.

Van Belle E, Rioufol G, Pouillot C, et al. Outcome impact of coronary revascularization strategy reclassification with fractional flow reserve at time of diagnostic angiography: insights from a large French multicenter fractional flow reserve registry. Circulation. 2014;129:173-185.

Toth GG, De Bruyne B, Kala P, et al. Study design of the graft Patency after FFR-guided versus angiography-guided CABG trial (GRAFFITI). J Cardiovasc Transl Res. 2018;11:269-273.

Thuesen AL, Riber LP, Veien KT, et al. Fractional flow reserve versus angiographically-guided coronary artery bypass grafting. J Am Coll Cardiol. 2018;72:2732-2743.

Glineur D, Grau JB, Etienne PY, et al. Impact of preoperative fractional flow reserve on arterial bypass graft anastomotic function: the IMPAG trial. Eur Heart J. 2019;40:2421-2428.

Fournier S, Toth GG, Colaiori I, De Bruyne B, Barbato E. Long-term patency of coronary artery bypass grafts after fractional flow reserve-guided implantation. Circ Cardiovasc Interv. 2019;12:e007712.