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Use of fractional flow reserve versus stress perfusion scintigraphy after unstable angina. Effect on duration of hospitalization, cost, procedural characteristics, and clinical outcome.

Abstract：

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 > or = 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 > or = 0.75. Patients with a positive SPS and those with an FFR <0.75 underwent percutaneous transluminal coronary angioplasty. 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 US dollars +/- 44 US dollars vs. 2,113 US dollars +/- 120 US dollars, 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.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Leesar MA,Abdul-Baki T,Akkus NI,Sharma A,Kannan T,Bolli R

doi

10.1016/s0735-1097(03)00057-3

subject

Has Abstract

pub_date

2003-04-02 00:00:00

pages

1115-21

issue

eissn

0735-1097

issn

1558-3597

pii

S0735109703000573

journal_volume

pub_type

临床试验,杂志文章,随机对照试验

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Use of fractional flow reserve versus stress perfusion scintigraphy after unstable angina. Effect on duration of hospitalization, cost, procedural characteristics, and clinical outcome.