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Fractional flow reserve (FFR) measurement as a routine part of coronary angiography in the work-up of angina held no advantages, only risks for patients, the RIPCORD 2 trial showed.

Management guided by the physiologic and visual combination didn't influence care as measured by total hospital costs at 12 months (£4,510 [about $6,200] vs £4,136, P=0.137) or quality of life on the visual analogue scale of the EuroQol EQ-5D-5L questionnaire (P=0.88).

Angina status and the rate of clinical events over the subsequent year were also similar between groups, reported Nicholas Curzen, PhD, of University Hospital Southampton NHS Foundation Trust in Southampton, England, at the European Society of Cardiology (ESC) virtual meeting.

Patients were no more likely to be referred for percutaneous coronary intervention (PCI), coronary artery bypass surgery, or optimal medical therapy alone depending on randomized group assignment.

"We have to conclude that, despite the attraction of the concept, this strategy had no overall advantage compared to angiography alone and would not be beneficial in routine clinical practice," Curzen said at an ESC press conference.

He called it somewhat surprising that there was zero impact on outcome from taking FFR to the extreme.

"I think one of the reasons this trial does not show a benefit from systematic FFR is probably because we don't need to know vessel-specific ischemia to make a management plan above and beyond just looking at an angiogram," Curzen said. "Although that will be a very unattractive, unpalatable fact for some interventional cardiologists, this trial pretty definitively tells us that is true. And it is pretty consistent really with the results of the ISCHEMIA trial."

The trial included 1,136 patients headed to the cath lab at 17 U.K. centers for diagnosis of stable angina or non-ST segment elevation myocardial infarction. They were randomized to assessment and management determined according to angiographic appearance alone or with the addition of FFR of all arteries of a caliber that could be revascularized (median four vessels).

Not surprisingly, the FFR group had longer procedure times by a mean of 16 minutes, more contrast used, and higher radiation exposure (all P<0.001).

FFR uptake has been underwhelming even in indications for which there is good evidence from prior trials (like , , and ) in the setting of patients already committed to PCI, Curzen noted.

"I suspect that people who are underutilizing the pressure wire even before will potentially use this result to do even less, which is not really what I would hope happens," he told 番茄社区 at the press conference.

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