Title: Trends and Outcomes in the Use of Adjunctive Fractional Flow Reserve From a Large Multi-Centre PCI Registry
Abstract: Increasing evidence supports the use of fractional flow reserve (FFR) to accurately determine which coronary artery lesions are appropriate for intervention. We aim to describe the use of FFR guided PCI in a large Australian PCI registry. We evaluated data from consecutive patients in the VCOR registry from 2014 to 2020 who presented with stable coronary artery disease or NSTEACS and underwent FFR-guided PCI in a single procedure. They were compared to a cohort who underwent standard angiographically-guided PCI over the same period. A total of 59,401 patients were included in the study with 2,455 (4.1%) undergoing FFR-guided PCI. FFR-guided PCI patients less often presented with a NSTEACS (22% vs 39%, p<0.001), were less likely to have their procedure out-of-hours (4.8% vs 10.6%, p<0.001) and more likely to have radial access (70% vs 59%, p<0.001). The use of FFR increased over the study period (2.8% of all cases in 2014 vs 4.7% in 2020, p<0.001). FFR-guided PCI was more often performed on the LAD (65% of all cases vs 42%, p<0.001). 30-day mortality was less in the FFR-guided group (0.2% vs 0.6%, p=0.005) but overall rates were very low. This observational study demonstrates that FFR is underutilised in the Australian context however use is increasing. Lower rates of ACS presentation in the FFR guided group corresponds with the established evidence base in patients with stable coronary disease. Given guideline recommendations and strong trial evidence FFR should be utilised more often to guide revascularisation.