FRACTIONAL FLOW RESERVE-GUIDED PCI IN PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE.
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Keywords
Coronary artery disease, Fractional flow reserve, Percutaneous coronary intervention, Major adverse cardiac events, Canadian Cardiovascular Society grading, Seattle Angina Questionnaire, Multivessel disease.
Abstract
Background: Coronary artery disease (CAD) significantly impacts morbidity and mortality. Percutaneous coronary intervention (PCI) is often used, especially for multivessel CAD. FFR-guided PCI aims to improve outcomes by identifying ischemia-causing lesions.
Objective: This study evaluated the effectiveness of FFR-guided PCI versus angiography-guided PCI in multivessel CAD patients.
Methods: A prospective study at Armed forces institute of cardiology Rawalpindi, Pakistan in the duration from October, 2023 to March, 2024. It involved 246 Patients aged 40-85 with multivessel CAD were included. Exclusions were left main CAD, significant valvular disease, previous bypass surgery, or inability to consent. Patients were split into FFR-guided PCI (FFR ≤ 0.80) and angiography-guided PCI groups. Conventional medical treatment was given. Primary outcomes measured were the improvement of fractional flow reserve (FFR) post-PCI. Secondary outcomes included major adverse cardiac events (MACE), angina status (CCS grading), and quality of life (SAQ). Data were analyzed using SPSS version 26.0. Paired t-tests compared continuous variables; chi-square tests assessed categorical data. Multivariate logistic regression identified outcome predictors. Kaplan-Meier survival analysis evaluated survival outcomes.
Results: The cohort's mean age was 65.2 years (SD 9.3). Males comprised 64.2% (158) and females 35.8% (88). The average BMI was 27.6 kg/m² (SD 4.8). Comorbidities included hypertension (56.5%), diabetes mellitus (38.2%), and prior myocardial infarction (29.7%). Preoperative FFR increased from 0.65 to 0.88 post-PCI (p < 0.001). MACE risk was 7.3%, with mortality at 2.4%, myocardial infarctions at 3.7%, and repeat revascularizations at 1.2%. CCS grade improved from 3.2 to 1.4 (p < 0.001). SAQ scores rose from 45.3 to 78.9 (p < 0.001).
Conclusion: FFR-guided PCI significantly improves FFR, reduces MACE, and enhances angina status and quality of life in multivessel CAD patients. These results support integrating FFR into routine clinical practice for optimal patient outcomes.
References
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