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SHR Neuro Krebs Kardio Lipid Stoffw Microb

Di Gioia, G; Pellicano, M; Toth, GG; Casselman, F; Adjedj, J; Van Praet, F; Ferrara, A; Stockman, B; Degrieck, I; Bartunek, J; Trimarco, B; Wijns, W; De Bruyne, B; Barbato, E.
Fractional Flow Reserve-Guided Revascularization in Patients With Aortic Stenosis.
Am J Cardiol. 2016; 117(9):1511-1515 Doi: 10.1016/j.amjcard.2016.02.023
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Toth-Gayor Gabor

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Fractional flow reserve (FFR) has never been investigated in patients with aortic stenosis (AS). From 2002 to 2010, we identified 106 patients with AS and coronary artery disease with at least one intermediate lesion treated according to FFR guidance. We matched 212 contemporary control patients with AS in which revascularization was decided on angiography only. More patients in the FFR-guided group underwent percutaneous coronary intervention (24% vs 13%; p = 0.019), whereas there was a trend toward less coronary artery bypass grafting (CABG) performed. After FFR, the number of diseased vessels was downgraded within the FFR-guided group (from 1.85 ± 0.97 to 1.48 ± 1; p <0.01) and compared with the angio-guided group (1.48 ± 1 vs 1.8 ± 0.97; p <0.01). Less aortic valve replacement was reported in the FFR-guided group (46% vs 57%; p = 0.056). In patients who underwent CABG, less venous conduits (0.5 ± 0.69 vs 0.73 ± 0.76; p = 0.05) and anastomoses (0.61 ± 0.85 vs 0.94 ± 1; p = 0.032) were necessary in the FFR-guided group. Up to 5 years, we found no difference in major adverse cardiac events (38% vs 39%; p = 0.98), overall death (32% vs 31%; p = 0.68), nonfatal myocardial infarction (2% vs 2%; p = 0.79), and revascularization (8% vs 7%; p = 0.76) between the 2 groups. In conclusion, FFR guidance impacts the management of selected patients with moderate or severe AS and coronary artery disease by resulting into deferral of aortic valve replacement, more patients treated with percutaneous coronary intervention, and in patients treated with CABG, into less venous grafts and anastomoses without increasing adverse event rates up to 5 years. Copyright © 2016 Elsevier Inc. All rights reserved.
Find related publications in this database (using NLM MeSH Indexing)
Aged -
Aged, 80 and over -
Aortic Valve Stenosis - complications
Coronary Angiography -
Coronary Artery Bypass -
Coronary Artery Disease - complications
Coronary Artery Disease - diagnosis
Coronary Artery Disease - surgery
Female -
Fractional Flow Reserve, Myocardial -
Humans -
Kaplan-Meier Estimate -
Male -
Middle Aged -
Percutaneous Coronary Intervention -
Retrospective Studies -
Treatment Outcome -

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