Fractional Flow Reserve: Review of the latest data
|
|
- Daisy Williams
- 5 years ago
- Views:
Transcription
1 Fractional Flow Reserve: Review of the latest data Michalis Hamilos, MD, PhD, FESC University Hospital of Heraklion
2 Fractional Flow Reserve (FFR) Coronary angiography does not always tell the truth Most of the patients coming to the catheterization laboratory had never a non- invasive test Need for a simple and reliable tool to provide information about the haemodynamic significance of a coronary stenosis This needs to be available inside the cath lab
3 Myocardial Fractional Flow Reserve: Definition Fractional Flow Reserve is a ratio FFR = Q s max max Q N maximal myocardial flow in the stenotic territory normal maximal myocardial flow FFR = extent (%) to which the epicardial stenosis limits maximal myocardial blood flow
4 Myocardial Fractional Flow Reserve: Definition S Q max N Q max = FFR P a P d P v (P d -P v ) / R myo P d -P v FFR = = = S N (P a -P v ) / R myo P a -P v P d P a
5 Fractional Flow Reserve FFR = P distal / P proximal during maximal flow FFR = P d / P a = 49/79 = 0.69
6 Threshold Values of FFR to Detect Significant Stenosis FFR non-signif. stenosis significant FFR < 0.75 always ischaemia (specificity 100 %) FFR > 0.80 ischaemia very unlikely (sensitivity 90 %) Pijls et al, NEJM1996
7 Features of FFR Has a normal value = 1.0 for every patient and every artery Is not influenced by changing hemodynamic conditions Accounts for collaterals Is easy to measure (success rate 99 %) and extremely reproducible Pressure measurement has un unequaled spatial resolution
8 FFR: Trials
9 FFR for Intermediate Lesion Assessment: The DEFER study Patients scheduled for PCI without Proof of Ischemia (n=325) Randomization deferral of PTCA (167) performance of PTCA (158) FFR 0.75 (91) FFR < 0.75 (76) FFR < 0.75 (68) FFR 0.75 (90) No PTCA PTCA PTCA PTCA DEFER Group REFERENCE Group PERFORM Group Bech et al, Circulation 2001
10 FFR for Intermediate Lesion Assessment: The DEFER study FFR > 0.75 FFR > 0.75 Bech et al, Circulation 2001
11 Cardiac Death and Acute MI after 5 years 20 % P=0.20 P< P< DEFER PERFORM REFERENCE FFR > 0.75 FFR < 0.75 Pijls et al, JACC 2007
12 Patient with stenoses 50% in at least 2 of the 3 major epicardial vessels Indicate all stenoses 50% considered for stenting Randomization Angiography-guided PCI FFR-guided PCI Measure FFR in all indicated stenoses Stent all indicated stenoses Stent only those stenoses with FFR year follow-up
13 Assessed for eligibility N=1905 Randomized N=1005 Not eligible N= 900 Left main stenosis N= 157 Extreme coronary tortuosity or calcification N= 217 No informed consent N= 105 Contra-indication for DES N= 86 Participation in other study N= 94 Logistic reasons N= 210 Other reasons N= 31 Angiographyguided PCI N=496 Lost to follow-up N=11 Analyzed N=496 CVTI, London 2010 FFR-guided PCI N=509 Lost to follow-up N=8 Analyzed N=509
14 FAME study: Adverse Events at 1 year ANGIO-group N=496 FFR-group N=509 P-value Events at 1 year, No (%) Death, MI, CABG, or repeat-pci 91 (18.4) 67 (13.2) 0.02 Death 15 (3.0) 9 (1.8) 0.19 Death or myocardial infarction 55 (11.1) 37 (7.3) 0.04 CABG or repeat PCI 47 (9.5) 33 (6.5) 0.08 Total no. of MACE Myocardial infarction, specified All myocardial infarctions 43 (8.7) 29 (5.7) 0.07 Small periprocedural CK-MB 3-5 x N Other infarctions ( late or large ) Tonino et al, NEJM 2009
15 1 Year Results from FAME 1. Improved outcomes 2. Decreased cost Absolute Difference in MACE-Free Survival 3. Less contrast use 4. Similar procedure time FFR-guided PCI Angio FFR Angio-guided PCI 5.3% 360 days p=0.02 $6,007 vs $5,332, p< ml vs 272 ml, p< min vs 71 min, p=0.51 Tonino et al, NEJM 2009
16 FAME: 2 years FU Fearon et al, TCT 2009
17 Adverse Events at 2 Years Angio- Guided n = 496 FFR- Guided n = 509 P Value Total no. of MACE Individual Endpoints Death 19 (3.8) 13 (2.6) 0.25 Myocardial Infarction 48 (9.7) 31 (6.1) 0.03 CABG or repeat PCI 61 (12.3) 53 (10.4) 0.35 Composite Endpoints Death or Myocardial Infarction 63 (12.7) 43 (8.4) 0.03 Death, MI, CABG, or re-pci 110 (22.2) 90 (17.7) 0.07 Fearon et al, TCT 2009
18 274 patients with LMCA 26 patients with protected LMCA 10 patients with valvular disease 213 patients enrolled 4 patients requiring surgery but treated medically 21 patients requiring surgery for other vessel disease 138 Nonsurgical group 75 Surgical group 2 patients lost in FU 2 patients lost in FU 136 patients included in the analysis 73 patients included in the analysis Hamilos et al, Circulation 2009
19 % Survival 5-year Survival p=0.48 FFR 0.80 FFR< No at risk Months FFR FFR< Hamilos et al, Circulation 2009
20 FFR for proximal LAD lesions 852 patients with isolated proximal LAD stenosis 730 patients eligible for the study 546 patients with an FFR 0.80, treated medically 166 patients with an FFR<0.80 treated by revascularization O Muller et al, JACC Interv 2011
21 FFR for proximal LAD lesions 564 patients FFR>0.80, medical 166 patients FFR<0.80, PCI/CABG B P = P = Medical group Revascularization group SURVIVAL at risk >= < Medical group Revascularization group MACE No at risk FFR >= FFR < O Muller et al, JACC Interv 2011
22 FFR for proximal LAD lesions O Muller et al, JACC Interv 2011
23 FAME 2 Stable CAD patients scheduled for 1, 2 or 3 vessel DES-PCI N = 1220 Randomized Trial FFR in all target lesions Registry At least 1 stenosis with FFR 0.80 (n=888) When all FFR > 0.80 (n=332) Randomization 1:1 PCI + MT 73% MT 27% MT 50% randomly assigned to FU Follow-up after 1, 6 months, 1, 2, 3, 4, and 5 years
24 FAME 2: Primary Outcomes Cumulative incidence (%) 30 No. at risk MT PCI+MT Registry 0 PCI+MT vs. MT: HR 0.32 ( ); p<0.001 PCI+MT vs. Registry: HR 1.29 ( ); p=0.61 MT vs. Registry: HR 4.32 ( ); p< Months after randomization De Bruyne et al, NEJM 2012
25 Cumulative incidence (%) Cumulative (%) Kaplan-Meier plots of Landmark Analysis of Death or MI days: HR 7.99 ( ); p=0.038 > 8 days: HR 0.42 ( ); p=0.053 p-interaction: p= Days after randomization PCI plus MT MT alone 7 days 5 0 >8 days 07days Months after randomization MT alone PCI plus MT De Bruyne et al, NEJM 2012
26 One Year Cost Estimates Per Patient FFR-Guided PCI MT Baseline $8,790 $3,305 Drug-Eluting Stent(s) $4,304 $48 Follow-up $2,584 $5,561 Revascularization $442 $3,928 Total $11,374 $8,866 Fearon et al, TCT 2012
27 Cumulative Costs over 12 Months $2,508 $5,485 % of study population 100% 56% 11% Fearon et al, TCT 2012
28 Quality of Life at 1 Month Angina (%) FFR-Guided PCI MT p-value Class <0.001 Class <0.001 Utility Change <0.001 Fearon et al, TCT 2012
29 FFR-Guided Strategy & Clinical Outcome STUDY 5 year survival 5 year event free survival DEFER (deferred group) 97% 79% FAME 1-FFR group (2 y) 97% 82% FFR Left Main (deferred group) 90% 74% FFR LAD (deferred group) 92.9% 89.7% FAME 2- Registry (1y) 100% 97% Controls (Rotterdam) 89.6% Risk Factors No disease(4 y)* 91.7% 83.4% * REACH Registry, JAMA 2010
30 Impact of downstream stenoses on LM FFR When FFR LM + FFR LAD >0.65, FFR LM measured is valuable Daniels et al, JACC interv 2012
31 Conclusions FFR is a well studied, simple and reliable means of assessing stenosis functional severity FFR value + anatomical information from angiography give a complete all in one assessment for patients with CAD FFR guided revascularization strategy has strong data to support the safe deferral of non ischemic coronary lesions (FFR>0.80) FFR should be considered as an indispensable imaging modality inside the cath lab
PCIs on Intermediate Lesions NCDR Cath-PCI Registry
Practical Application Of Coronary Physiology in The Cath Lab Talal T Attar, MD, MBA, FACC PCIs on Intermediate Lesions NCDR Cath-PCI Registry Fraction of stenoses 50-70% treated with PCI without further
More informationFFR Incorporating & Expanding it s use in Clinical Practice
FFR Incorporating & Expanding it s use in Clinical Practice Suleiman Kharabsheh, MD Consultant Invasive Cardiology Assistant professor, Alfaisal Univ. KFHI - KFSHRC Concept of FFR Maximum flow down a vessel
More informationFFR in Multivessel Disease
FFR in Multivessel Disease April, 26 2013 Coronary Physiology in the Catheterization Laboratory Location: European Heart House, Nice, France Pim A.L. Tonino, MD, PhD Hartcentrum, Eindhoven, the Netherlands
More informationBenefit of Performing PCI Based on FFR
Benefit of Performing PCI Based on FFR William F. Fearon, MD Associate Professor Director, Interventional Cardiology Stanford University Medical Center Benefit of FFR-Guided PCI FFR-Guided PCI vs. Angiography-Guided
More informationManagement of stable CAD FFR guided therapy: the new gold standard
Management of stable CAD FFR guided therapy: the new gold standard Suleiman Kharabsheh, MD Director; CCU, Telemetry and CHU Associate professor of Cardiology, Alfaisal Univ. KFHI - KFSHRC Should patients
More informationCost-Effectiveness of Fractional Flow Reserve
Cost-Effectiveness of Fractional Flow Reserve William F. Fearon, MD Associate Professor of Medicine Director, Interventional Cardiology Stanford University Medical Center Cost-Effectiveness of FFR What
More informationFractional Flow Reserve. A physiological approach to guide complex interventions
Fractional Flow Reserve A physiological approach to guide complex interventions What is FFR? Fractional Flow Reserve (FFR) is a lesion specific, physiological index determining the hemodynamic severity
More informationFractional Flow Reserve and the 1 Year Results of the FAME Study
Imaging and Physiology Summit Seoul, Korea, November 22, 2008 Fractional Flow Reserve and the 1 Year Results of the FAME Study William F. Fearon, M.D. Assistant Professor Division of Cardiovascular Medicine
More informationFAME STUDY: 2-year Follow-Up & CLINICAL SUBGROUP ANALYSIS
Coronary Physiology In The Cathlab FAME STUDY: 2-year Follow-Up & CLINICAL SUBGROUP ANALYSIS Educational Training Program ESC European Heart House april 7th 9th 2011 Nico H.J.Pijls, MD, PhD Catharina Hospital,
More informationCLINICAL CONSEQUENCES OF THE
CLINICAL CONSEQUENCES OF THE FAME STUDY TCT ASIA Seoul, Korea, april 26 th, 2012 Nico H. J. Pijls, MD, PhD Catharina Hospital, Eindhoven, The Netherlands GUIDELINES ESC SEPTEMBER 2010 FFR UPGRADED TO LEVEL
More informationAngor Stable: de COURAGE à FAME 2. Maladie coronaire stable et coronarographie en De COURAGE à FAME 2
Maladie coronaire stable et coronarographie en 2013 De COURAGE à FAME 2 Bernard De Bruyne, MD, PhD Cardiovascular Center Aalst OLV-Clinic Aalst, Belgium COURAGE Trial Aim To compare optimal medical therapy
More informationFractional Flow Reserve and the Results of the FAME Study
Imaging and Physiology Summit Seoul, Korea November 21 st, 2009 Fractional Flow Reserve and the Results of the FAME Study William F. Fearon, M.D. Assistant Professor Division of Cardiovascular Medicine
More informationRelations of Interest
Relations of Interest Consulting Fees on my behalf go to the Cardiovascular Research Center Aalst Contracted Research between the Cardiovascular Research Center Aalst and several pharmaceutical and device
More informationFractional Flow Reserve: Basics, FAME 1, FAME 2. William F. Fearon, MD Associate Professor Stanford University Medical Center
Fractional Flow Reserve: Basics, FAME 1, FAME 2 William F. Fearon, MD Associate Professor Stanford University Medical Center Conflict of Interest Advisory Board for HeartFlow Research grant from St. Jude
More informationDave Kettles, St Dominics Hospital East London.
Dave Kettles, St Dominics Hospital East London. 110 x 150 Angina for a couple of months Trop T negative T wave inversion across the chest leads Not wanting to risk radial Huge struggle with femoral
More informationFRACTIONAL FLOW RESERVE: STANDARD OF CARE
FRACTIONAL FLOW RESERVE: FROM INVESTIGATIONAL TOOL TO STANDARD OF CARE TCT ASIA Seoul, Korea, april 26 th, 2012 Nico H. J. Pijls, MD, PhD Catharina Hospital, Eindhoven, The Netherlands FRACTIONAL FLOW
More informationFractional Flow Reserve (FFR) --Practical Set Up Pressure Measurement --
Fractional Flow Reserve (FFR) --Practical Set Up Pressure Measurement -- JoonHyung Doh, MD, PhD Assistant Professor, Vision21 Cardiac and Vascular Center Inje University Ilsan Paik Hospital Goyang, Korea
More informationCoronary stenting: the appropriate use of FFR
Coronary stenting: the appropriate use of FFR Morton J. Kern, MD Professor of Medicine Chief of Cardiology LBVA Associate Chief Cardiology University California Irvine Orange, California To treat or not
More informationFFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium
FFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium Conflict of Interest Institutional research grants and speaker s fee from St. Jude Medical and Boston Scientic to Cardiovascular
More informationDebate Should we use FFR? I will say NO.
Debate Should we use FFR? I will say NO. Hyeon-Cheol Gwon Cardiac and Vascular Center Samsung Medical Center Sungkyunkwan University School of Medicine Dr. Hyeon-Cheol Gwon Research fund from Abbott Korea
More information3 Year Clinical Outcome and Cost-Effectiveness of FFR- Guided PCI in Stable Patients with Coronary Artery Disease: FAME 2 Trial
3 Year Clinical Outcome and Cost-Effectiveness of FFR- Guided PCI in Stable Patients with Coronary Artery Disease: FAME 2 Trial William F. Fearon, MD, Takeshi Nishi, MD, Bernard De Bruyne, MD, PhD, Derek
More informationFFR= Qs/Qn. Ohm s law R= P/Q Q=P/R
32 ο Πανελλήνιο Καρδιολογικό Συνζδριο, Θεσσαλονίκη 20/10/2011 Gould KL et al, JACC CARDIOVASC IMAG 2009 Gould KL et al AM J CARDIOL 1974 & JACC CARDIOVASC IMAG 2009 Under maximal hyperemia: Rs=Rn FFR=
More informationFRACTIONAL FLOW RESERVE USE IN THE CATH LAB BECAUSE ANGIOGRAPHY ALONE IS NOT ENOUGH!!!!!!!!
FRACTIONAL FLOW RESERVE USE IN THE CATH LAB BECAUSE ANGIOGRAPHY ALONE IS NOT ENOUGH!!!!!!!! Juan Antonio Pastor-Cervantes,M.D FSCAI, FACC Cardiovascular Institute Memorial Regional Hospital Hollywood Florida
More informationIntroducing. Integrated FFR Platform
Introducing Integrated FFR Platform Fractional Flow Reserve (FFR) Definition of FFR Maximum achievable blood flow in stenotic coronary artery divided by maximum blood flow in the same artery without stenosis.
More informationFRACTIONAL FLOW RESERVE Step-by-step measurement, Practical tips & Pitfalls
FRACTIONAL FLOW RESERVE Step-by-step measurement, Practical tips & Pitfalls Ahmed M ElGuindy, MSc, MRCP(UK) Division of Cardiology Aswan Heart Centre 2013 Fractional Flow Reserve Essential diagnostic tool
More informationROLE OF CORONARY PRESSURE & FFR IN MULTIVESSEL DISEASE
ROLE OF CORONARY PRESSURE & FFR IN MULTIVESSEL DISEASE Angioplasty Summit TCT ASIA Seoul, Korea, april 24th, 2008 Nico H. J. Pijls, MD, PhD Catharina Hospital, Eindhoven, The Netherlands A rather common
More informationDo stents deserve the bad press? Mark A. Tulli MD, FACC
Do stents deserve the bad press? Mark A. Tulli MD, FACC Disclosures: None Introduction Stents don t help people. Stents are bad for patients. Heart Treatment Overused WSJ Study Finds Doctors Often Too
More informationIntervention: How and to which extent is technology helping us?
Cardiological Society of India Congress 12th February 2016 Chennai, India Intervention: How and to which extent is technology helping us? SIMONE BISCAGLIA MD CARDIOVASCULAR INSTITUTE, FERRARA, ITALY Introduction
More informationFFR in Left Main Disease
FFR in Left Main Disease William F. Fearon, MD Associate Professor of Medicine Director, Interventional Cardiology Stanford University Medical Center Why FFR instead of IVUS? Physiologic versus anatomic
More informationΣεμινάριο Ομάδων Εργασίας Fractional Flow Reserve (FFR) Σε ποιούς ασθενείς; ΔΗΜΗΤΡΗΣ ΑΥΖΩΤΗΣ Επιστ. υπεύθυνος Αιμοδυναμικού Τμήματος, Βιοκλινική
ΕΛΛΗΝΙΚΗΚΑΡΔΙΟΛΟΓΙΚΗΕΤΑΙΡΕΙΑ Σεμινάριο Ομάδων Εργασίας 2011 Fractional Flow Reserve (FFR) Σε ποιούς ασθενείς; ΔΗΜΗΤΡΗΣ ΑΥΖΩΤΗΣ Επιστ. υπεύθυνος Αιμοδυναμικού Τμήματος, Βιοκλινική GUIDELINES ON MYOCARDIAL
More informationControversies in Coronary Revascularization. Atlanta CCU April 15, 2016
Controversies in Coronary Revascularization Atlanta CCU April 15, 2016 Habib Samady MD FACC FSCAI Professor of Medicine Director, Interventional Cardiology, Emory University Director, Cardiac Catheterization
More informationFFR-Guided PCI. 4 th Imaging and Physiology Summit October 29 th, 2010 Seoul, Korea. Stanford
4 th Imaging and Physiology Summit October 29 th, 2010 Seoul, Korea FFR-Guided PCI William F. Fearon, M.D. Associate Professor Division of Cardiovascular Medicine University Medical Center Disclosure Statement
More informationIVUS vs FFR Debate: IVUS-Guided PCI
IVUS vs FFR Debate: IVUS-Guided PCI Gary S. Mintz, MD Cardiovascular Research Foundation New York, NY Disclosure Statement of Financial Interest Within the past 12 months, I have had a financial interest/arrangement
More informationCoronary artery disease (CAD): Fractional Flow Reserve (FFR) for Pilots Risk Assessment. B. Haaff, R. Quast
Coronary artery disease (CAD): Fractional Flow Reserve (FFR) for Pilots Risk Assessment B. Haaff, R. Quast Aeromedical Center Germany, Stuttgart-Airport Westpfalz-Klinikum, Kaiserslautern, Germany Disclosure
More informationPCI reduces death/myocardial infarction in stable patients with silent ischemia
PCI reduces death/myocardial infarction in stable patients with silent ischemia Stephane Fournier, Yuhei Kobayashi, William F. Fearon, Bruno Roza da Costa, Carlos Collet, Panos Xaplanteris, Frederik Zimmerman,
More informationFractional Flow Reserve (FFR) Shown to Improve Patient Outcomes and Reduce Costs. Executive Summary
(FFR) Shown to Improve Patient Outcomes and Reduce s Keywords Fractional Flow Reserve, coronary artery disease, stenosis, blood flow blockages Published: 5 October 213 Citation: RadcliffeCardiology.com,
More informationFractional Flow Reserve (FFR)
Non-invasive FFR using coronary CT angiography and computational fluid dyn amics predicts the hemodynamic signifi cance of coronary lesions First in man experience with CT-Flow Andrejs Erglis, Sanda Jegere,
More informationFractional Flow Reserve Guided PCI versus Medical Therapy in Stable Coronary Disease. FAME 2 Trial
Fractional Flow Reserve Guided PCI versus Medical Therapy in Stable Coronary Disease FAME 2 Trial Clinicaltrials.gov NCT01132495 Bernard De Bruyne, Nico H.J. Pijls, William F Fearon, Peter Juni, Emanuele
More informationFractional Flow Reserve and instantaneous wave -free Ratio. Λάμπρος Κ. Μόσιαλος Επεμβατικός Καρδιολόγος ΓΝ Παπαγεωργίου
Fractional Flow Reserve and instantaneous wave -free Ratio Λάμπρος Κ. Μόσιαλος Επεμβατικός Καρδιολόγος ΓΝ Παπαγεωργίου DISCLOSURES There are no financial conflicts of interest relevant to this presentation
More informationFractional Flow Reserve (FFR) --Practical Set Up Pressure Measurement --
Fractional Flow Reserve (FFR) --Practical Set Up Pressure Measurement -- Joon Hyung Doh, MD, PhD Associate Professor, Division of Cardiology Inje University Ilsan Paik Hospital Goyang, Korea 목차 Fractional
More informationCT FFR: Are you ready to totally change the way you diagnose Coronary Artery Disease?
CT FFR: Are you ready to totally change the way you diagnose Coronary Artery Disease? Madan Mohan MD MRCP FACC CQO, Division of Cardiovascular Medicine University Hospitals Case Medical Center Assistant
More informationEXCEL vs. NOBLE: How to Treat Left Main Disease in 2017 AATS International Cardiovascular Symposium December 8-9, 2017
EXCEL vs. NOBLE: How to Treat Left Main Disease in 2017 AATS International Cardiovascular Symposium December 8-9, 2017 Igor F. Palacios, MD Director of Interventional Cardiology Professor of Medicine Massachusetts
More informationIntegrated Use of IVUS and FFR for LM Stenting
Integrated Use of IVUS and FFR for LM Stenting Gary S. Mintz, MD Cardiovascular Research Foundation Four studies have highlighted the inaccuracy of angiography in the assessment of LMCA disease Fisher
More informationThree-Year Clinical Outcomes with Everolimus-Eluting Bioresorbable Scaffolds: Results from the Randomized ABSORB III Trial Stephen G.
Three-Year Clinical Outcomes with Everolimus-Eluting Bioresorbable Scaffolds: Results from the Randomized ABSORB III Trial Stephen G. Ellis MD Dean J. Kereiakes MD and Gregg W. Stone MD for the ABSORB
More informationPROMUS Element Experience In AMC
Promus Element Luncheon Symposium: PROMUS Element Experience In AMC Jung-Min Ahn, MD. University of Ulsan College of Medicine, Heart Institute, Asan Medical Center, Seoul, Korea PROMUS Element Clinical
More informationFractional Flow Reserve (FFR) estimation GRAIDIS CHRISTOS. EUROMEDICA-KYΑNOUS STAVROS Interventional Cardiologist, FSCAI
Fractional Flow Reserve (FFR) estimation Why, how, when? GRAIDIS CHRISTOS EUROMEDICA-KYΑNOUS STAVROS Interventional Cardiologist, FSCAI "Innovations in Interventional Cardiology & Electrophysiology IICE
More informationAun-Yeong Chong MD, MRCP(UK), MBBS University of Ottawa Heart Institute
Aun-Yeong Chong MD, MRCP(UK), MBBS University of Ottawa Heart Institute Cardiac Imaging Symposium Oct 2013 Invasive Coronary Artery Assessment Coronary angiography IntraVascular UltraSound (IVUS) Optical
More informationHow to approach non-infarct related artery disease in patients with STEMI in a limited resource setting
How to approach non-infarct related artery disease in patients with STEMI in a limited resource setting Ahmed A A Suliman, MBBS, FACP, FESC Associate Professor, University of Khartoum Interventional Cardiologist,
More informationEffect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial
Effect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial Myeong-Ki Hong, MD. PhD on behalf of the IVUS-XPL trial investigators
More informationApproach to Multi Vessel disease with STEMI
Approach to Multi Vessel disease with STEMI MANAGEMENT OF ST-ELEVATION MYOCARDIAL INFARCTION Dr. Thomas Alexander, M.D; D.M; F.A.C.C. Senior Consultant and Interventional Cardiologist Kovai Medical Centre
More informationHybrid cardiac imaging Advantages, limitations, clinical scenarios and perspectives for the future
Hybrid cardiac imaging Advantages, limitations, clinical scenarios and perspectives for the future Prof. Juhani Knuuti, MD, FESC Turku, Finland Disclosure: Juhani Knuuti, M.D. Juhani Knuuti, M.D. has financial
More informationFocus on Acute Coronary Syndromes
Focus on Acute Coronary Syndromes Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium Potential conflicts of interest Consulting fees and honoraria on my behalf go to the Cardiovascular
More informationAnatomy is Destiny, But Physiology is Here Today
Published on Journal of Invasive Cardiology (http://www.invasivecardiology.com) September, 2010 [1] Anatomy is Destiny, But Physiology is Here Today Thu, 9/9/10-10:54am 0 Comments Section: Commentary Issue
More informationTechnical Aspects and Clinical Indications of FFR
Technical Aspects and Clinical Indications of FFR Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst - OLV Clinic Aalst, Belgium Potential conflicts of interest Consulting fees and honoraria on
More informationCoronary interventions
Controversial issues in the management of ischemic heart failure Coronary interventions Maciej Lesiak Department of Cardiology, University Hospital in Poznan none DECLARATION OF CONFLICT OF INTEREST CHF
More informationThe Latest on CT Fractional Flow Reserve. Dimitris Mitsouras, Ph.D.
The Latest on CT Fractional Flow Reserve Dimitris Mitsouras, Ph.D. Assistant Professor of Radiology Harvard Medical School Director, Applied Imaging Science Lab Brigham and Women s Hospital Disclosures
More informationFFR in unstable angina and after MI F
FFR in unstable angina and after MI F June-Hong Kim, MD. PhD Cardiovascular center Pusan National University Yangsan Hospital FFR tells you physiologic stenosis severity rather than anatomical stenosis
More informationFFR and intravascular imaging, which of which?
FFR and intravascular imaging, which of which? Ayman Khairy MD, PhD, FESC Associate professor of Cardiovascular Medicine Vice Director of Assiut University Hospitals Assiut, Egypt Diagnostic assessment
More informationWhat do the guidelines say?
Percutaneous coronary intervention in 3-vessel disease and main stem What do the guidelines say? Nothing to disclose Dariusz Dudek Institute of Cardiology, Jagiellonian University Krakow, Poland The European
More informationControversies in Cardiac Surgery
Controversies in Cardiac Surgery 3 years after SYNTAX : Percutaneous Coronary Intervention for Multivessel / Left main stem Coronary artery disease Pro ESC Congress 2010, 28 August 1 September Stockholm
More informationNew Insight about FFR and IVUS MLA
New Insight about FFR and IVUS MLA Can IVUS MLA Predict FFR
More informationFractional Flow Reserve from Coronary CT Angiography (and some neat CT images)
Fractional Flow Reserve from Coronary CT Angiography (and some neat CT images) Victor Cheng, M.D. Director, Cardiovascular CT Oklahoma Heart Institute 1 Disclosures Tornadoes scare me 2 Treating CAD Fixing
More informationLeft Main Intervention: Where are we in 2015?
Left Main Intervention: Where are we in 2015? David A. Cox, MD FSCAI Director, Cardiology Research Associate Director, Cardiac Cath Lab Lehigh Valley Health Network Allentown, PA Fall Fellows Course Laa
More informationPCI for Stable Ischemic Heart Disease: What Happened in the Last Week?
PCI for Stable Ischemic Heart Disease: What Happened in the Last Week? Ajay J. Kirtane, MD, SM Center for Interventional Vascular Therapy Columbia University Medical Center / NewYork Presbyterian Hospital
More informationhigh SYNTAX Score? I Sheiban Division of Cardiology Interventional Card. University of Turin Turin / Italy
What to do with patients with high SYNTAX Score? I Sheiban Division of Cardiology Interventional Card. University of Turin San Giovanni Battista Hospital Turin / Italy Who are the patients with high SYNTAX
More informationSurgery Grand Rounds
Surgery Grand Rounds Coronary Artery Bypass Grafting versus Coronary Artery Stenting Charles Ted Lord, R1 Coronary Artery Disease Stenosis of epicardial vessels Metabolic & hematologic Statistics 500,000
More informationThree-vessel fractional flow reserve measurement for predicting clinical prognosis in patients with coronary artery disease
Editorial Three-vessel fractional flow reserve measurement for predicting clinical prognosis in patients with coronary artery disease Takashi Kubo, Hiroki Emori, Yosuke Katayama, Kosei Terada Department
More informationInstantaneous Wave-Free Ratio
Instantaneous Wave-Free Ratio Alejandro Aquino MD Interventional Cardiology Fellow Washington University in St. Louis Barnes-Jewish Hospital Instantaneous Wave-Free Ratio Alejandro Aquino MD Disclosure
More informationChun & McGee Am J Med 2004;117:334
Chun & McGee Am J Med 2004;117:334 Tests non invasifs et vie réelle 398.978 patients Pas d ATCD coronaire non invasive test before 83.9% Sténose >70% = 37.6% multivessel disease 53% Un test non invasif
More informationMalaysian Healthy Ageing Society
Organised by: Co-Sponsored: Malaysian Healthy Ageing Society CAD INVESTIGATIONS PHYSIOLOGICAL / FUNCTIONAL VS ANATOMICAL / STRUCTURAL Disclosure iheal medical centre is a one stop cardiac centre with
More informationCan We Safely Defer PCI. Yes, already proven
Can We Safely Defer PCI Just Based on FFR>0.80? Yes, already proven Seung-Jung Park, MD., PhD. Professor of Medicine, University of Ulsan, College of Medicine Heart Institute, Asan Medical Center, Seoul,
More informationLeft Main PCI vs. CABG: Real World
Management of Patients with Stable CAD Left Main PCI vs. CABG: Real World Marco Roffi, MD, FESC University Hospital Geneva, Switzerland SYNTAX-LMT The SYNTAX trial included a pre-specified subgroup of
More informationFFR-guided Jailed Side Branch Intervention
FFR-guided Jailed Side Branch Intervention - Pressure wire in Bifurcation lesions - Bon-Kwon Koo, MD, PhD Seoul National University Hospital, Seoul, Korea Bifurcation Lesions Bifurcation Lesions Still
More informationUpgrade of Recommendation
Challenges in LM PCI Decision-making process for stenting Young-Hak Kim, MD, PhD, Heart Institute, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea Upgrade of Recommendation for
More informationPhysiology (FFR & IFR) is Essential in Daily Pratice. Martine Gilard Brest University - France
Physiology (FFR & IFR) is Essential in Daily Pratice Martine Gilard Brest University - France Background Invasive assessment of atherosclerotic coronary artery lesion Morphological assessment IVUS X-ray
More informationInterventional Cardiology
Interventional Cardiology Cost effectiveness of fractional flow reserve-guided percutaneous coronary intervention In recent years, fractional flow reserve (FFR) has become accepted as a clinically effective
More informationISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions
Julinda Mehilli, MD Deutsches Herzzentrum Technische Universität Munich Germany ISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions Background Left main
More informationCT or PET/CT for coronary artery disease
CT or PET/CT for coronary artery disease Rotterdam 2012 Juhani Knuuti, MD, PhD, FESC Turku PET Centre University of Turku Turku, Finland Juhani.knuuti@utu.fi Turku PET Centre University of Turku Åbo Akademi
More informationKomplexe Koronarintervention heute: Von Syntax zu bioresorbierbaren Stents
Komplexe Koronarintervention heute: Von Syntax zu bioresorbierbaren Stents Prof. Dr. med. Julinda Mehilli Medizinische Klinik und Poliklinik I Klinikum der Universität München Campus Großhadern Key Factors
More informationPressureWire Aeris with Agile Tip Technology. Wireless FFR Functionality and Handles like a Workhorse PCI Guidewire 1
Home» Products» All International Products» PressureWire Aeris with Agile Tip Technology PressureWire Aeris with Agile Tip Technology This device is commercially available for use in select international
More informationCoronary Physiology the current state of play
Coronary Physiology the current state of play Background The concept of using the trans-stenotic pressure gradient in a diseased coronary artery as a measure to guide percutaneous coronary intervention
More informationTrial. International Study of Comparative Health Effectiveness with Medical and Invasive Approaches
Trial International Study of Comparative Health Effectiveness with Medical and Invasive Approaches Stable Ischemic Heart Disease What is the best initial management strategy for patients with SIHD? What
More informationTRATAMIENTO INVASIVO ENFERMEDAD ISQUEMICA ESTABLE. Jonathan Poveda CLINICA BIBLICA 2015
TRATAMIENTO INVASIVO ENFERMEDAD ISQUEMICA ESTABLE Jonathan Poveda CLINICA BIBLICA 2015 COURAGE First coronary angioplasty lesion (circles) two days before (A), immediately after (B), and one month after
More informationLeft Main Intervention: Will it become standard of care?
Left Main Intervention: Will it become standard of care? David Cox, MD FSCAI, FACC Director, Interventional Cardiology Research Associate Director, Cardiac Cath Lab Lehigh Valley Health Network Allentown,
More informationCoronary Plaque Sealing: The DEFER Study and more...
Coronary Plaque Sealing: The DEFER Study and more... How Waiting Can Be Beneficial in Stable Coronary Artery Disease Patients ESC, Stockholm, 2005 M. Romanens, 21.09.2005 at www.kardiolab.ch DEFER Study:
More informationCan Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO!
Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO! Young-Hak Kim, MD, PhD Heart Institute, University of Ulsan College of Medicine Asan Medical Center,
More informationBetter CABGs vs Better PCI Devices
CABG vs PCI 2017 Multivessel Coronary Disease Better CABGs vs Better PCI Devices ACC New York, Dec 8, 2017 No Disclosures CABG vs PCI 2017 Stable Multivessel Coronary Disease 1. Are These The two Critical
More informationLM stenting - Cypher
LM stenting - Cypher Left main stenting with BMS Since 1995 Issues in BMS era AMC Restenosis and TLR (%) 3 27 TLR P=.282 Restenosis P=.71 28 2 1 15 12 Ostium 5 4 Shaft Bifurcation Left main stenting with
More informationFractional Flow Reserve Versus Angiography for Guiding Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease
Journal of the American College of Cardiology Vol. 56, No. 3, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.04.012
More informationThe Impact of Sex Differences on Fractional Flow Reserve Guided Percutaneous Coronary Intervention
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 5, NO. 10, 2012 2012 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00 PUBLISHED BY ELSEVIER INC. http://dx.doi.org/10.1016/j.jcin.2012.06.016
More informationAdvances in Cardiovascular Diagnosis and Therapy. No disclosure or conflicts. Outline
Advances in Cardiovascular Diagnosis and Therapy Firas Zahr, MD Assistant Professor of Medicine Interventional Cardiology University Of Iowa No disclosure or conflicts Outline What is new with revascularization?
More informationΚλινική Χρήση IVUS και OCT PERIKLIS A. DAVLOUROS ASSOCIATE PROFESSOR OF CARDIOLOGY INVASIVE CARDIOLOGY & CONGENITAL HEART DISEASE
Κλινική Χρήση IVUS και OCT PERIKLIS A. DAVLOUROS ASSOCIATE PROFESSOR OF CARDIOLOGY INVASIVE CARDIOLOGY & CONGENITAL HEART DISEASE Conflict of interest None to declare While IVUS is the most used intravascular
More informationSTEMI AND MULTIVESSEL CORONARY DISEASE
STEMI AND MULTIVESSEL CORONARY DISEASE ΤΣΙΑΦΟΥΤΗΣ Ν. ΙΩΑΝΝΗΣ ΕΠΕΜΒΑΤΙΚΟΣ ΚΑΡΔΙΟΛΟΓΟΣ Α ΚΑΡΔΙΟΛΟΓΙΚΗ ΝΟΣ ΕΡΥΘΡΟΥ ΣΤΑΥΡΟΥ IRA 30-50% of STEMI patients have additional stenoses other than the infarct related
More informationTreatment Options for Angina
Treatment Options for Angina Interventional Cardiology Perspective Michael A. Robertson, M.D. 10/30/10 Prevalence of CAD in USA 15 million Americans with CAD 2 million diagnostic catheterizations 1 million
More informationSYNTAX III REVOLUTION Trial Press briefing conference. Prof. Patrick W. Serruys MD, PhD Principal Investigator Imperial College of London
SYNTAX III REVOLUTION Trial Press briefing conference Prof. Patrick W. Serruys MD, PhD Principal Investigator Imperial College of London Title: Coronary Computed Tomography Angiography for Heart Team Decision-making
More informationChun & McGeeAm J Med 2004;117:334
Chun & McGeeAm J Med 2004;117:334 Tests non invasifs et vie réelle 398.978 patients Pas d ATCD coronaire non invasive test before 83.9% Sténose >70% = 37.6% - multivessel disease 53% Un test non invasif
More informationFFR vs. icecg in Coronary Bifurcations (FIESTA) - preliminary results. Dobrin Vassilev MD, PhD National Heart Hospital Sofia, Bulgaria
FFR vs. icecg in Coronary Bifurcations (FIESTA) - preliminary results Dobrin Vassilev MD, PhD National Heart Hospital Sofia, Bulgaria I would like to express my personal gratitude to Dr. BK Koo for opening
More informationEvaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013
Evaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013 Disclosures Consultant- St Jude Medical Boston Scientific Speaker- Volcano Corporation Heart
More informationCulprit PCI vs MultiVessel PCI for Acute Myocardial Infarction
Culprit PCI vs MultiVessel PCI for Acute Myocardial Infarction Dipti Itchhaporia, MD, FACC, FESC Trustee, American College of Cardiology Director of Disease Management, Hoag Hospital Robert and Georgia
More informationDiffuse Disease and Serial Stenoses. Bernard De Bruyne Cardiovascular Center Aalst Belgium
Diffuse Disease and Serial Stenoses Bernard De Bruyne Cardiovascular Center Aalst Belgium Atherosclerosis is a Diffuse Disease Serial Stenoses A B P a P m P d When A is isolated, hyperemic flow through
More information