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. 2024 Feb 9:11:1337941.
doi: 10.3389/fcvm.2024.1337941. eCollection 2024.

Fractional flow reserve measurements and long-term mortality-results from the FLORIDA study

Felicitas Boeckling  1 , Barbara E Stähli  2 , Tanja Rudolph  3 , Matthias Lutz  4 , Anne-Sophie Schatz  5 , Tobias Vogelmann  6 , Magnus Stueve  7 , Nick E J West  7 , Els Boone  7 , Aslihan Erbay  1 , David M Leistner  1
Affiliations

Fractional flow reserve measurements and long-term mortality-results from the FLORIDA study

Felicitas Boeckling et al. Front Cardiovasc Med. .

Abstract

Background: Randomized evidence suggested improved outcomes in fractional flow reserve (FFR) guidance of coronary revascularization compared to medical therapy in well-defined patient cohorts. However, the impact of FFR-guided revascularization on long-term outcomes of unselected patients with chronic or acute coronary syndromes (ACS) is unknown.

Aims: The FLORIDA (Fractional FLOw Reserve In cardiovascular DiseAses) study sought to investigate outcomes of FFR-guided vs. angiography-guided treatment strategies in a large, real-world cohort.

Methods: This study included patients enrolled into the German InGef Research Database. Patients undergoing coronary angiography between January 2014 and December 2015 were included in the analysis. Eligible patients had at least one inpatient coronary angiogram for suspected coronary artery disease between January 2014 and December 2015. Patients were stratified into FFR arm if a coronary angiography with adjunctive FFR measurement was performed, otherwise into the angiography-only arm. Matching was applied to ensure a balanced distribution of baseline characteristics in the study cohort. Patients were followed for 3 years after index date and primary endpoint was all-cause mortality.

Results: In the matched population, mortality at 3 years was 9.6% in the FFR-assessed group and 12.6% in the angiography-only group (p = 0.002), corresponding to a 24% relative risk reduction with use of FFR. This effect was most pronounced in patients in whom revascularization was deferred based on FFR (8.7% vs. 12.3%, p = 0.04) and in high-risk subgroups including patients aged ≥75 years (14.9% vs. 20.1%, p < 0.01) and those presenting with ACS (10.2% vs. 14.0%, p = 0.04).

Conclusions: FFR-based revascularization strategy was associated with reduced mortality at 3 years. These findings further support the use of FFR in everyday clinical practice.

Keywords: acute coronary syndrome; chronic coronary syndrome; fractional flow reserve; mortality; percutaneous coronary intervention; real-world evidence.

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Conflict of interest statement

BS reports grants from Boston Scientific and grants from Edwards Lifesciences outside the submitted work. TR reports personal fees from Vulcano Philips and personal fees from Abbott Vascular outside the submitted work. ML reports grants, personal fees and other from Abbott Medical during the conduct of the study. TV reports grants from Abbott Vascular during the conduct of the study, personal fees from Abbott Vascular, personal fees from B. Braun, personal fees from In review Boston Scientific, personal fees from Edwards Lifescience, all outside the submitted work. MS, NW and EB are employees of Abbott Vascular. DL reports personal fees and non-financial support from Abbott Vascular, during the conduct of the study, personal fees from Boston Scientific, grants and personal fees from Abbott Vascular outside the submitted work. FB, AS-S, and AE have nothing to disclose. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Study flow diagram of the FLORIDA study. Patients with at least one within-hospital angiography were included. Patients were matched for sex, presence of acute coronary syndrome, age ± 5 years, and propensity scores, with each FFR patient matched to the closest angiography-only patient (for details: see text). FFR, fractional flow reserve.
Figure 2
Figure 2
Treatment strategies in the total patient cohort, in patients undergoing FFR guidance, and in patients undergoing angiography guidance for PCI. Percentage of patients treated by PCI (blue) CABG (black), or optimal medical therapy (red) are shown. This proportion differed between patients evaluated by FFR (middle bar) and angiography-only (right bar), with a lower percentage of patients treated by PCI in the FFR group (p < 0.001). ABG, coronary artery bypass graft; FFR, fractional flow reserve; OMT, optimal medical therapy; PCI, percutaneous coronary intervention.
Figure 3
Figure 3
Survival in patients undergoing FFR or angiography guidance for coronary artery disease therapy. FFR, fractional flow reserve.
Figure 4
Figure 4
Survival curves for survival in subgroups of patients undergoing FFR or angiography guidance for coronary artery disease therapy. (A) Patients undergoing coronary revascularization by either PCI or CABG, (B) Patients undergoing optimal medical therapy, (C) patients presenting with ACS, and (D) patients presenting with CCS. ACS, acute coronary syndrome; CCS, chronic coronary syndrome; FFR, fractional flow reserve; OMT, optimal medical therapy.
See this image and copyright information in PMC

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