Registre F rançais FF R : R3F

1. Registre Français FFR : R3F Comité de pilotage : Patrick Dupouy (Antony), Eric Van Belle (Lille), Gilles Rioufol (Lyon), Christophe Pouillot (St Denis la Réunion), Thomas Cuisset (Marseille)

2. But du Registre • L’objectif de ce registre est d’évaluer l’utilisation du guide pression coronaire en France et la pratique de la technique de mesure FFR • Base à une discussion de reconnaissance de l’acte par les tutelles.

3. Description • Registre français, prospectif, multicentrique • Inclusions 2008-2010 • 1101 Patients • Suivi PH, 6 mois et 1 an • CRF Electronique (Clinigrid) • Sponsors • St Jude-Radi • Biotronik

4. Critères d’évaluation Critère d’évaluation primaire : • étude de la répartition des indications d’utilisation de la FFR • adéquation de la mesure FFR avec les décisions thérapeutiques • Impact de la FFR sur la décision thérapeutique • suivi clinique des MACE (évènement cardiaque majeur) jusqu’à 12 mois et relation avec la valeur initiale de FFR. • Critères d’évaluation secondaires : • appréciation de la valeur seuil utilisée • évaluation des coûts • pertinence de la mesure FFR dans l’ensemble des explorations fonctionnelles pratiquées

5. Indications d’utilisation 14% 3,9% 5%

6. Baseline characteristics (n=945)

7. Baseline characteristics (n=945)

8. Baseline characteristics (n=945)

9. Baseline characteristics (n=945)

10. Baseline characteristics (n=945)

11. Baseline characteristics (n=945)

12. Résumé • 1101 Patients inclus • Base clôturée et figée • Adjudication des évènements terminée Résultats R3F PCR 2012

13. Methods • To investigate this issue the investigators were asked to define prospectively their revascularization strategy before performing the FFR (“A priori” strategy). • This was compared to the final strategy applied to the patient after performing the FFR. • Multivariable models were constructed in order to describe the revascularization decision process. • The results of the first 945 consecutive patients are presented.

14. P=0.02

15. Modified Change of strategy in 47% of individuals 100% 7 11 P=0.0001 5 80% 21 37 CABG 60% 16 PCI 19 40% Conservative 52 20% 33 0% A priori Final

16. Change of Revascularization strategy according to the « a priori » strategy group N= +181 N= -174 N= -65 N= -58 100% 8 10 32 Final strategy 80% 26 4 CABG 42 60% PCI 40% Conservative 64 64 50 20% 0% Conserv. PCI CABG n=491 n=350 n=104 « A priori » strategy

17. Multivariate analysis Encoding • Conservative = 0 • PCI= 1 • CABG = 2 • Change in Revascularization strategy was encoded as the difference between the final strategy minus the « a priori » strategy.

18. Upgrade/Dowgrade Revascularization strategy:A multivariate model (FFR not included) Other variables in the model: Center, age, gender, previous MACE, symptoms, stability, non-invasive testing, LAD location, Reference diameter, MLD, ACC/AHA class.

19. Upgrade/Dowgrade Revascularization strategy:A multivariate model (FFR included) Other variables in the model: Center, Age, gender, previous MACE, symptoms, stability, non-invasive testing, Ejection fraction, Number of diseased vessels, LAD location, Reference diameter, MLD, % stenosis, ACC/AHA class.

20. Conclusions • The present report, based on a large French multicenter registry, demonstrates that although FFR had little impact on the overall rate of revascularization in patients referred for coronary angiography, it modifies the individual decision in about 1 out of 2 patients. • This set of data provides additional support to the concept of "FFR guided revascularization" as an important tool to tailor the revascularization strategy in patients with CAD.