Use of fractional flow reserve significantly improved 1-year mortality rates in adults with stable ischemic heart disease, according to a review of 17,989 patients.

Although fractional flow reserve (FFR) has demonstrated value in guiding coronary revascularization, its impact on outcomes in patients with stable ischemic heart disease has not been well studied in a large population, wrote Rushi V. Parikh, MD, of the University of California, Los Angeles, and colleagues.

In a study published in the Journal of the American College of Cardiology, the researchers analyzed data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program for adults who underwent coronary angiography between January 2009 and September 2017. The study included patients with angiographically intermediate disease, defined as 40%-69% diameter stenosis on visual inspection.

The rate of FFR use increased from 14.8% to 18.5% during the study period for all patients with intermediate lesions, and from 44% to 75% for those who had percutaneous coronary intervention, the researchers wrote.

Overall, based on hazard models, 1-year mortality was significantly lower in patients who underwent FFR, compared with those who had angiography only (2.8% vs. 5.9%; P less than 0.001). In addition, FFR use in revascularization was associated with a 43% reduced 1-year mortality risk, compared with angiography only.

The findings were limited by several factors, including the observational nature of the study, inability to distinguish between cardiovascular and noncardiovascular mortality, lack of data on the technical performance of the FFR, and a relatively short follow-up period, the researchers noted.

However, the results were strengthened by the large sample size, and support the use of FFR-guided revascularization in patients with angiographically intermediate stenosis, they wrote.

“Future registry-based studies accounting for all physiologic modalities are warranted to accurately quantify the landscape of coronary physiology-guided revascularization,” they added.

The study was supported in part by the Rocky Mountain Regional VA Medical Center in Aurora, Colo. Lead author Dr. Parikh had no financial conflicts to disclose.

SOURCE: Parikh RV et al. J Am Coll Cardiol. 2020 Feb 4;75:409-19.