TY - JOUR
T1 - Use of fractional flow reserve versus stress perfusion scintigraphy after unstable angina
T2 - Effect on duration of hospitalization, cost, procedural characteristics, and clinical outcome
AU - Leesar, Massoud A.
AU - Abdul-Baki, Talal
AU - Akkus, Nuri I.
AU - Sharma, Anil
AU - Kannan, Tarif
AU - Bolli, Roberto
PY - 2003/4/2
Y1 - 2003/4/2
N2 - OBJECTIVES: The present study sought to determine the value of fractional flow reserve (FFR) compared with stress perfusion scintigraphy (SPS) in patients with recent unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI). BACKGROUND: Fractional flow reserve, an invasive index of stenosis severity, is a reliable surrogate for SPS in patients with normal left ventricular function. An FFR ≥0.75 can distinguish patients after myocardial infarction (MI) with a positive SPS from those with a negative SPS. However, the use of FFR has not been investigated after UA/NSTEMI. METHODS: Seventy patients who had recent UA/NSTEMI and an intermediate single-vessel stenosis were randomized to either SPS (n = 35) or FFR (n = 35). Patients in the SPS group were discharged if the SPS revealed no ischemia, whereas those in the FFR group were discharged if the FFR was ≥0.75. Patients with a positive SPS and those with an FFR <0.75 underwent percutaneous transluminal coronary angioplasty. RESULTS: The use of FFR markedly reduced the duration and cost of hospitalization compared with SPS (11 ± 2 h vs. 49 ± 5 h [-77%], p < 0.001; and $1,329 ± $44 vs. $2,113 ± $120, respectively, p < 0.05). There were no significant differences in procedure time, radiation exposure time, or event rates during follow-up, including death, MI, or revascularization. CONCLUSIONS: These data indicate that: 1) the use of FFR in patients with recent UA/NSTEMI markedly reduces the duration and cost of hospitalization compared with SPS; and 2) these benefits are not associated with an increase in procedure time, radiation exposure time, or clinical event rates.
AB - OBJECTIVES: The present study sought to determine the value of fractional flow reserve (FFR) compared with stress perfusion scintigraphy (SPS) in patients with recent unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI). BACKGROUND: Fractional flow reserve, an invasive index of stenosis severity, is a reliable surrogate for SPS in patients with normal left ventricular function. An FFR ≥0.75 can distinguish patients after myocardial infarction (MI) with a positive SPS from those with a negative SPS. However, the use of FFR has not been investigated after UA/NSTEMI. METHODS: Seventy patients who had recent UA/NSTEMI and an intermediate single-vessel stenosis were randomized to either SPS (n = 35) or FFR (n = 35). Patients in the SPS group were discharged if the SPS revealed no ischemia, whereas those in the FFR group were discharged if the FFR was ≥0.75. Patients with a positive SPS and those with an FFR <0.75 underwent percutaneous transluminal coronary angioplasty. RESULTS: The use of FFR markedly reduced the duration and cost of hospitalization compared with SPS (11 ± 2 h vs. 49 ± 5 h [-77%], p < 0.001; and $1,329 ± $44 vs. $2,113 ± $120, respectively, p < 0.05). There were no significant differences in procedure time, radiation exposure time, or event rates during follow-up, including death, MI, or revascularization. CONCLUSIONS: These data indicate that: 1) the use of FFR in patients with recent UA/NSTEMI markedly reduces the duration and cost of hospitalization compared with SPS; and 2) these benefits are not associated with an increase in procedure time, radiation exposure time, or clinical event rates.
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U2 - 10.1016/S0735-1097(03)00057-3
DO - 10.1016/S0735-1097(03)00057-3
M3 - Article
C2 - 12679210
AN - SCOPUS:0037414081
SN - 0735-1097
VL - 41
SP - 1115
EP - 1121
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 7
ER -