Visual Assessment by Seasoned Operators versus Fractional Flow Reserve Guided Stenting in Patients with Multivessel Disease in Indian Patients

Vikrant Vijan, Anjith Vupputuri, Manav Aggarwal, Sanjeev Chintamani, Bishnu Kiran Rajendran, Gurpreet Singh, Muthiah Subramanian and Rajesh Thachathodiyl

Background: The benefit of revascularization is less clear in stenotic lesions that do not induce ischemia and medical therapy alone is likely to be equally effective. FFR (Fractional Flow Reserve) identifies stenoses that are causing reversible ischemia and thereby the operator can guide interventions to the lesions responsible for the patient’s problem, saving time, cost and optimizing clinical outcome. The main aim is to compare FFR and visual assessment with respect to decision making, requirements of stents and corresponding outcomes in patients with multivessel coronary artery disease. Method: This was a prospective, observational, single centre study, which included 38 patients randomized into 2 groups: one group that underwent FFR guided stenting for the borderline lesions, if the FFR value was found to be significant and for the other group the decision to go ahead with stenting for borderline lesions was based on independent opinion of 4 cardiologists participating in the study, based on visual assessment. The patients were followed up at 3 and 6 months. The primary endpoint of the study was death due to any cause or ACS (Acute Coronary Syndrome). The number of stents saved, cost savings and symptomatic improvement were the secondary outcomes that were studied. Inter-observer variation within the 4 operators in both the FFR and visual arms was also analysed. Results: There were no deaths or ACS during 3 and 6 months follow-up in the 38 patients that were included in the two groups. There was no statistical difference with regards to number of stents saved, cost savings, and functional outcomes such as angina; which were our secondary end points between the visual assessment by seasoned operators and FFR guided stenting groups. There was inter-observer variation between all the 4 operators in our study with regards to visual assessment of the borderline lesions. Conclusion: FFR is important in decision making in borderline lesions and it should be used more often, especially where there are single operators.