{"id":44038,"date":"2014-07-11T08:00:23","date_gmt":"2014-07-11T12:00:23","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&#038;p=44038"},"modified":"2014-07-10T21:31:53","modified_gmt":"2014-07-11T01:31:53","slug":"do-ffr-and-ivus-feed-the-elephant","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/07\/11\/do-ffr-and-ivus-feed-the-elephant\/","title":{"rendered":"Do FFR and IVUS Feed the Elephant?"},"content":{"rendered":"<p><em>In <a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1881929\">an observational study<\/a> of all patients who underwent PCI in National Health Service hospitals in London between January 1, 2004, and July 31, 2011 (n = 41,688), <b>fractional flow reserve (FFR)-guided and intravascular ultrasonography (IVUS)-guided PCI were not associated with improved long-term survival when compared with standard angiography-guided PCI<\/b> (performed on the basis of visual lesion assessment).\u00a0<\/em><\/p>\n<p>In <a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1881927\">an accompanying editorial<\/a>, Aseem Malhotra remarks: \u201c<b><i>The elephant in the room<\/i><\/b> is that randomized studies (including patients at low risk and high risk) have not demonstrated outcomes benefit for stenting stable coronary disease in addition to optimal medical therapy despite its widespread use.\u201d<\/p>\n<p>This follows on the heels of <a href=\"http:\/\/circ.ahajournals.org\/content\/129\/18\/1871.long\">a recent Circulation paper<\/a>\u00a0by Hopkins cardiologist, Armin Arbab-Zadeh, who notes that \u201cThe rationale for the <b><i>FFR concept<\/i><\/b>\u2026is based on a common <b><i>misconception<\/i><\/b> of the relationship between provocable myocardial ischemia and risk of adverse cardiac events.\u201d<\/p>\n<p><strong>\u00a0JOIN THE DISCUSSION<\/strong><\/p>\n<p><b><i>Does FFR\/IVUS guided-PCI prevent MI or death?<\/i><\/b><\/p>\n<p><b><i>Are FFR and IVUS overused or underused?<\/i><\/b><\/p>\n<p><b><i>Do you ever discuss FFR or IVUS with your patients?<\/i><\/b><\/p>\n<p><b><i>Does treating provocable ischemia with PCI prevent MI or death?<\/i><\/b><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Rick Lange and David Hillis wonder whether the debate about the role of FFR and IVUS in patient selection for PCI is a red herring in the larger issue of revascularization in patients with stable CAD.<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,9],"tags":[1027,666,301,940],"class_list":["post-44038","post","type-post","status-publish","format-standard","hentry","category-cardiac-imaging","category-interventional-cardiology","tag-ffr","tag-ivus","tag-pci","tag-stable-cad"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/44038","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=44038"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/44038\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=44038"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=44038"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=44038"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}