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CLINICAL STUDY

Use of fractional flow reserve versus stress perfusion scintigraphy after unstable angina

Effect on duration of hospitalization, cost, procedural characteristics, and clinical outcome

^* Division of Cardiology, University of Louisville and Jewish Hospital Heart and Lung Institute, Louisville, Kentucky, USA

Manuscript received April 11, 2002; revised manuscript received September 13, 2002, accepted October 31, 2002.

^* Reprint requests and correspondence: Dr. Massoud A. Leesar, Division of Cardiology, University of Louisville, Louisville, Kentucky 40292, USA.
malees01{at}louisville.edu

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.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   FFR = fractional flow reserve   MI = myocardial infarction   PCI = percutaneous coronary intervention   RN = registered nurse   RT = radiologic technologist   SPECT = single-photon emission computed tomography   SPS = stress perfusion scintigraphy   TCU = transitional care unit   Tl-201 = thallium   UA/NSTEMI = unstable angina/non–ST-segment elevation myocardial infarction

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