Usually the decision to stent a coronary vessel is primarily determined by the % stenosis of the vessel. In this RCT of >1000 patients, they were randomized to stenting according to angiography alone, or to angiography in addition to the Fractional Flow Reserve (FFR; ratio of maximal blood flow in a stenotic vessel versus normal maximal blood flow). In the FFR group, the vessel was stented only if the FFR was <0.8. The numbers of stents per patient in the standard group was 2.7, versus 1.8 in the FFR group. The primary endpoint (1-year death, MI, or re-vascularization) occured in 18% of the standard group and only 13% of the FFR group. We should be aware that using FFR in addition to standard angiography will likely be used to guide stenting decisions in the cath lab. (abstract)
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.