Coronary interventions

Graft patency after FFR-guided versus angiography-guided coronary artery bypass grafting: the GRAFFITI trial

EuroIntervention 2019;15:e999-e1005. DOI: 10.4244/EIJ-D-19-00463

Gabor Toth
Gabor G. Toth1,2, MD, PhD; Bernard De Bruyne2, MD, PhD; Petr Kala3, MD, PhD; Flavio L. Ribichini4, MD, PhD; Filip Casselman2, MD, PhD; Ruben Ramos5, MD; Zsolt Piroth6, MD, PhD; Stephane Fournier2, MD; Anna Piccoli4, MD; Carlos Van Mieghem2, MD, PhD; Martin Penicka2, MD, PhD; Martin Mates7, MD; Petr Nemec8, MD; Frank Van Praet2, MD; Bernard Stockman2, MD; Ivan Degriek2, MD; Emanuele Barbato2,9, MD, PhD
1. University Heart Center Graz, Division of Cardiology, Department of Medicine, Medical University Graz, Graz, Austria; 2. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium; 3. Department of Cardiology and Internal Medicine, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic; 4. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy; 5. Hospital Santa Marta - Centro Hospitalar Lisboa Central, Lisbon, Portugal; 6. Hungarian Institute of Cardiology, Budapest, Hungary; 7. Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic; 8. Centre of Cardiovascular and Transplant Surgery, Brno, Czech Republic; 9. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

Aims: The aim of this study was to assess prospectively the clinical benefits of fractional flow reserve (FFR) in guiding coronary artery bypass grafting (CABG).

Methods and results: GRAFFITI is a single-blinded, prospective, multicentre, randomised controlled trial of FFR-guided versus angiography-guided CABG. We enrolled patients undergoing coronary angiography, having a significantly diseased left anterior descending artery or left main stem and at least one more major coronary artery with intermediate stenosis, assessed by FFR. Surgical strategy was defined based on angiography, blinded to FFR values prior to randomisation. After randomisation, patients were operated on either following the angiography-based strategy (angiography-guided group) or according to FFR, i.e., with an FFR ≤0.80 as cut-off for grafting (FFR-guided group). The primary endpoint was graft patency at 12 months. Between March 2012 and December 2016, 172 patients were randomised either to the angiography-guided group (84 patients) or to the FFR-guided group (88 patients). The patients had a median of three [3; 4] lesions; diameter stenosis was 65% (50%; 80%), FFR was 0.72 (0.50; 0.82). Compared to the angiography-guided group, the FFR-guided group received fewer anastomoses (3 [3; 3] vs 2 [2; 3], respectively; p=0.004). One-year angiographic follow-up showed no difference in overall graft patency (126 [80%] vs 113 [81%], respectively; p=0.885). One-year clinical follow-up, available in 98% of patients, showed no difference in the composite of death, myocardial infarction, target vessel revascularisation and stroke.

Conclusions: FFR guidance of CABG has no impact on one-year graft patency, but it is associated with a simplified surgical procedure. Identifier: NCT01810224

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

fractional flow reservemultiple vessel disease
Coronary interventionsStable CAD
Read next article
BIOFLOW-IV, a randomised, intercontinental, multicentre study to assess the safety and effectiveness of the Orsiro sirolimus-eluting stent in the treatment of subjects with de novo coronary artery lesions: primary outcome target vessel failure at 12 months

Latest news