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Real-world use of fractional flow reserve in Germany: results of the prospective ALKK coronary angiography and PCI registry

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Abstract

Background

There is growing evidence for beneficial prognostic and economic effects of FFR-guided treatment of stable coronary artery disease. We sought to evaluate the real-world use of FFR measurements in patients undergoing elective coronary angiography.

Methods and results

We analyzed the data of the prospective ALKK coronary angiography and PCI registry including data of 38 hospitals from January 2010 to December 2013. A total of 100,977 patients undergoing coronary angiography were included. In 3240 patients (3.2 %) intracoronary pressure measurement was performed. There was a wide range of use of FFR measurement in the different analyzed ALKK hospitals from 0.1 to 8.8 % in elective patients with suspected or known coronary artery disease (median 2.7 %, quartiles 0.9 and 5.3 %), with a successive increase of use over time during the study period. Overall, it was performed in 3.2 % of coronary angiographies. Use in patients with three-vessel disease (2.5 %) and recommendation for bypass surgery (1.6 %) was less frequent. In procedures without PCI, dose area product was higher in the FFR group (2641 cGy × cm2 vs. 2368 cGy × cm2, p < 0.001), while it was lower in procedures with ad hoc PCI (4676 cGy × cm2 vs. 5143 cGy × cm2, p < 0.001). The performing center turned out to be the strongest predictor.

Conclusions

The use of FFR measurement was very heterogeneous between different hospitals and in general relatively low, in particular in patients with multivessel disease or recommendation for bypass surgery, but there was a positive trend during the study period. Technically, FFR measurement was not associated with an increased periprocedural complication rate.

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Authors and Affiliations

  1. Klinik für Kardiologie, Klinikum Oldenburg gGmbH, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany

    Tobias Härle & Albrecht Elsässer

  2. Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany

    Uwe Zeymer & Ralf Zahn

  3. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany

    Uwe Zeymer & Matthias Hochadel

  4. Klinik für Kardiologie, Herz- und Gefäß-Klinik GmbH, Bad Neustadt a. d., Haale, Germany

    Sebastian Kerber

  5. Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Landshut, Germany

    Bernhard Zrenner

  6. Klinikum Fulda, Medizinische Klinik I, Fulda, Germany

    Volker Schächinger

  7. Klinik für Kardiologie, Zentralklinik Bad Berka, Bad Berka, Germany

    Bernward Lauer

  8. Klinikum Wetzlar, Medizinische Klinik I, Wetzlar, Germany

    Thorsten Runde

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  1. Tobias Härle
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  2. Uwe Zeymer
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  10. Albrecht Elsässer
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Correspondence to Tobias Härle.

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Härle, T., Zeymer, U., Hochadel, M. et al. Real-world use of fractional flow reserve in Germany: results of the prospective ALKK coronary angiography and PCI registry. Clin Res Cardiol 106, 140–150 (2017). https://doi.org/10.1007/s00392-016-1034-5

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  • DOI: https://doi.org/10.1007/s00392-016-1034-5

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