Outcomes in Fractional flow reserve guided Percutaneous Coronary Intervention among Indian patients

Background: Coronary Artery Disease (CAD) is a leading cause of mortality worldwide. Revascularisation of stenotic segments has been the standard of care. However, the benefit of revascularisation is less evident for lesions that do not cause ischemia, and optimal medical therapy alone is probably just as beneficial in these cases. Fractional Flow Reserve (FFR) is a metric that gauges the physiological importance of coronary stenosis. This method hasn’t achieved widespread adoption amongst the interventional cardiology community, with FFR utilised in only a minority of cases undergoing PCI, especially in India. Aim: To compare outcomes in FFR-guided vs angiography-guided Percutaneous Coronary Intervention (PCI) among Indian patients with intermediate stenosis (50%- 70%) on coronary angiography. Methods: This open-label study was conducted on patients with CAD with intermediate stenosis and requiring PCI. A total of 80 patients (40 in each arm) were included. Patients were eligible if they were diagnosed with stable CAD or ACS and had intermediate lesions on coronary angiography. “Cases” underwent FFR-guided PCI while the remaining patients were enrolled as “Controls.” Results: There was no significant difference in terms of primary outcomes. Anti-anginal medications at 3 and 6 months were significantly higher in the Control group and the EQ-5D score was significantly higher in the FFR group than in the Control group at 3 and 6 months (p<0.05). The mean stent length was significantly higher in the Control group than in the FFR group (P=0.023). The mean number of stents used in the FFR group was significantly lower than the Control group (P=0.033). Conclusion: Management of intermediate lesions with an FFR-guided strategy was associated with better outcomes regarding angina and functional parameters. FFRguided PCI reduces major adverse cardiovascular events at six months, a finding supporting the evolving strategy of revascularisation of ischemic lesions and medical treatment of physiologically non-ischemic lesions.