Publication details

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

Authors

TOTH Gabor G. DE BRUYNE Bernard KALA Petr RIBICHINI Flavio CASSELMAN Filip RAMOS Ruben PIROTH Zsolt FOURNIER Stephane PICCOLI Anna VAN MIEGHEM Carlos PENICKA Martin MATES Martin NEMEC Petr VAN PRAET Frank STOCKMAN Bernard DEGRIEK Ivan BARBATO Emanuele

Year of publication 2019
Type Article in Periodical
Magazine / Source Eurointervention
MU Faculty or unit

Faculty of Medicine

Citation
web http://dx.doi.org/10.4244/EIJ-D-19-00463
Doi http://dx.doi.org/10.4244/EIJ-D-19-00463
Keywords fractional flow reserve; multiple vessel disease
Description 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. ClinicalTrials.gov Identifier: NCT01810224

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