U.S. Trends in Inpatient Utilization of Fractional Flow Reserve and Percutaneous Coronary Intervention

Pothineni, Naga Venkata K.; Shah, Nishi; Rochlani, Yogita; Nairooz, Ramez; Raina, Sameer; Leesar, Massoud A.; Uretsky, Barry F.; Hakeem, Abdul

doi:10.1016/j.jacc.2015.11.042

Cited by 49 publications

(22 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, there was a significant increase in the use of FFR and IVUS, according to the Nationwide Inpatient Sample (NIS) database of patients undergoing left heart catheterization between 2009 and 2011 in the US. Specifically, the number of in-hospital FFR utilization in US increased from 1173 cases in 2008 to 21365 cases in 2012, representing an 18-fold rise 24). Further research studies are needed to elucidate the implementation of adjunct PCI support tools in lesions with different locations and different severities in our cohort.…”

Section: Discussionmentioning

confidence: 97%

The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry

et al. 2017

View full text Add to dashboard Cite

Background and ObjectivesAlthough several multicenter registries have evaluated percutaneous coronary intervention (PCI) procedures in Korea, those databases have been limited by non-standardized data collection and lack of uniform reporting methods. We aimed to collect and report data from a standardized database to analyze PCI procedures throughout the country.Materials and Methods Both clinical and procedural data, as well as clinical outcomes data during hospital stay, were collected based on case report forms that used a standard set of 54 data elements. This report is based on 2014 Korean PCI registry cohort data.ResultsA total of 92 hospitals offered data on 44967 PCI procedures. The median age was 66.0 interquartile range 57.0-74.0 years, and 70.3% were men. Thirty-eight percent of patients presented with acute myocardial infarction and one-third of all PCI procedures were performed in an urgent or emergency setting. Non-invasive stress tests were performed in 13.9% of cases, while coronary computed tomography angiography was used in 13.7% of cases prior to PCI. Radial artery access was used in 56.1% of all PCI procedures. Devices that used PCI included drug-eluting stent, plain old balloon angioplasty, drug-eluting balloon, and bare-metal stent (around 91%, 19%, 6%, and 1% of all procedures, respectively). The incidences of in-hospital death, non-fatal myocardial infarction, and stroke were 2.3%, 1.6%, and 0.2%, respectively.ConclusionThese data may provide an overview of the current PCI practices and in-hospital outcomes in Korea and could be used as a foundation for developing treatment guidelines and nationwide clinical research.

show abstract

Section: Discussionmentioning

confidence: 97%

The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The clinical adaption of FFR is increasing, but remains low 1, 2, 19. The underlying reasons may include the high cost of pressure wires, tortuous vessels, and the need for pharmacological hyperemia induction.…”

Section: Discussionmentioning

confidence: 99%

“…Following the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [fractional flow reserve versus angiography for guiding percutaneous coronary intervention]) trials, the adoption of fractional flow reserve (FFR) has improved with a 16‐fold increase in FFR‐guided percutaneous coronary intervention in the United States from 2008 to 2012 1. Globally, the use of physiological lesion assessment remains low, with large areas performing less than 15% of eligible procedures with physiology guidance 2, 3…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study

Westra

Andersen

Campo

et al. 2018

JAHA

262

275

View full text Add to dashboard Cite

BackgroundQuantitative flow ratio (QFR) is a novel modality for physiological lesion assessment based on 3‐dimensional vessel reconstructions and contrast flow velocity estimates. We evaluated the value of online QFR during routine invasive coronary angiography for procedural feasibility, diagnostic performance, and agreement with pressure‐wire–derived fractional flow reserve (FFR) as a gold standard in an international multicenter study.Methods and Results FAVOR II E‐J (Functional Assessment by Various Flow Reconstructions II Europe‐Japan) was a prospective, observational, investigator‐initiated study. Patients with stable angina pectoris were enrolled in 11 international centers. FFR and online QFR computation were performed in all eligible lesions. An independent core lab performed 2‐dimensional quantitative coronary angiography (2D‐QCA) analysis of all lesions assessed with QFR and FFR. The primary comparison was sensitivity and specificity of QFR compared with 2D‐QCA using FFR as a reference standard. A total of 329 patients were enrolled. Paired assessment of FFR, QFR, and 2D‐QCA was available for 317 lesions. Mean FFR, QFR, and percent diameter stenosis were 0.83±0.09, 0.82±10, and 45±10%, respectively. FFR was ≤0.80 in 104 (33%) lesions. Sensitivity and specificity by QFR was significantly higher than by 2D‐QCA (sensitivity, 86.5% (78.4–92.4) versus 44.2% (34.5–54.3); P<0.001; specificity, 86.9% (81.6–91.1) versus 76.5% (70.3–82.0); P=0.002). Area under the receiver curve was significantly higher for QFR compared with 2D‐QCA (area under the receiver curve, 0.92 [0.89–0.96] versus 0.64 [0.57–0.70]; P<0.001). Median time to QFR was significantly lower than median time to FFR (time to QFR, 5.0 minutes [interquartile range, –6.1] versus time to FFR, 7.0 minutes [interquartile range, 5.0–10.0]; P<0.001).ConclusionsOnline computation of QFR in the catheterization laboratory is clinically feasible and is superior to angiographic assessment for evaluation of intermediary coronary artery stenosis using FFR as a reference standard.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02959814.

show abstract

“…Fractional flow reserve (FFR) is the reference-standard method to define flow-limiting lesions in the epicardial coronary compartment. FFR use is increasing [13, 14], and the European Society of Cardiology gives FFR a class 1A indication for the assessment of intermediate severity stenosis (defined as 50–90% diameter stenosis) [1, 15]. In the USA, the increasing frequency of FFR guidance has also been stimulated by recent appropriate use criteria and some private insurance companies require evidence of ischaemia by FFR assessment if percutaneous coronary intervention (PCI) is to be undertaken [16] (Fig.…”

Section: Introductionmentioning

confidence: 99%

Fractional flow reserve: a clinical perspective

Corcoran

Hennigan

Berry

2017

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

Fractional flow reserve (FFR) is a reference invasive diagnostic test to assess the physiological significance of an epicardial coronary artery stenosis. FFR-guided percutaneous coronary intervention in stable coronary artery disease has been assessed in three seminal clinical trials and the indications for FFR assessment are expanding into other clinical scenarios. In this article we review the theoretical, experimental and clinical basis for FFR measurement. We place FFR measurement in the context of the comprehensive invasive assessment of coronary physiology in patients presenting with known or suspected angina pectoris in daily clinical practice, and review the recent developments in FFR assessment.

show abstract

U.S. Trends in Inpatient Utilization of Fractional Flow Reserve and Percutaneous Coronary Intervention

Cited by 49 publications

References 4 publications

The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry

The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry

Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study

Fractional flow reserve: a clinical perspective

Contact Info

Product

Resources

About