Author + information
- Jad Al Danaf,
- Mitul Kanzaria,
- David Fischman,
- Nicholas Ruggiero II,
- Paul Walinsky,
- Matthew DeCaro and
- Michael Savage
Appropriate use criteria (AUC) for coronary revascularization were created to improve patient selection for percutaneous coronary intervention (PCI), but the AUC does not emphasize fractional flow reserve (FFR) as a means of determining appropriateness. Although few studies have examined national trends in PCI appropriateness and FFR use, none have examined FFR utilization as a means to reclassify PCI appropriateness. We hypothesize the incorporation of FFR into PCI-AUC could reclassify inappropriate and uncertain PCI into appropriate.
A cross-sectional analysis of 1,849 patients undergoing PCI between January 1, 2011 and December 31, 2015 in a single-center participating in the NCDR CathPCI registry was conducted. Data on FFR was obtained from our EMR for patients undergoing PCI that were classified as inappropriate or uncertain as determined by the NCDR. An FFR ≤0.80 was considered significant.
All PCI performed during the 5-year study period were classified as follows: 89.1%-appropriate, 8.4%-uncertain and 2.5%-inappropriate. Of the 10.9% uncertain and inappropriate PCI, 10.4% were FFR-guided. FFR utilization steadily increased from 0% in 2011 to 24.1% in 2015 as portrayed in the figure (p=0.007). All FFR were ≤0.80 and therefore incorporation of FFR in the AUC would have reclassified each of these procedures as appropriate.
In patients undergoing PCI classified as inappropriate or uncertain by current AUC standards, incorporation of FFR could have a significant impact on reclassifying the procedural appropriateness.