The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Graft patency after FFR-guided versus angiography-guided coronary artery bypass grafting. The GRAFFITI trial

DOI: 10.4244/EIJ-D-19-00463

1. Medizinische Universitat Graz, Cardiology, 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. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
6. Hospital Santa Marta - Centro Hospitalar Lisboa Central, Lisbon, Portugal
7. Hungarian Institute of Cardiology, Budapest, Hungary
8. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
9. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
10. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
11. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
12. Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic
13. Centre of Cardiovascular and Transplant Surgery, Brno, Czech Republic
14. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
15. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
16. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
17. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy, ITALY
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Aims: To prospectively assess clinical benefits of fractional flow reserve (FFR) in guiding coronary artery bypass grafting (CABG).

Methods and results: GRAFFITI is a single-blinded prospective multicenter randomized controlled trial for FFR-guided versus angiography-guided CABG. We enrolled patients, undergoing coronary angiography, having significantly diseased left anterior descending or left main stem and at least one more major coronary artery with intermediate stenosis, assessed by FFR. Surgical strategy was defined based on angiogram, blinded to FFR values prior to randomization. After randomization, patients were either operated following the angiogram-based strategy (Angiography-guided group) or according to FFR: i.e. with FFR≤0.80 as cut-off for grafting (FFR-guided group). Primary endpoint was graft patency at 12 months. Trial was registered (NCT01810224).Between March 2012 and December 2016, 172 patients were randomized either to angiography-guided (84 patients) or to FFR-guided group (88 patients). Patients had median of 3 [3;4] lesions. Diameter stenosis was 65% [50%;80%], FFR was 0.72 [0.50;0.82]. Compared to angiography-guided group, FFR-guided group received less 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 composite of death, myocardial infarction, target vessel revascularization and stroke.

Conclusions:FFR-guidance of CABG has no impact on 1-year graft patency, but it is associated with a simplified surgical procedure.

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