Background:In coronary artery bypass grafting (CABG), the use of fractional flow reserve (FFR) is insufficiently investigated. Stenosis assessment usually relies on visual estimates of lesion severity. This study evaluated health-related quality of life (HRQoL) and angina after FFR- versus angiography-guided CABG.Methods:One hundred patients referred for CABG were randomized to FFR- or angiography-guided CABG. In the FFR group, lesions with FFR>0.80 were deferred, while the surgeon was blinded to the FFR values in the angiography group. Before and 6 months after CABG, HRQoL was assessed by the health state classifier EQ-5D of the EuroQoL 5-level instrument and angina status based on the Canadian Cardiovascular Society classification system were registered.Results:Six-month angiography included FFR evaluations of deferred lesions. In total, completed EQ-5D of the EuroQoL 5-level instrument questionnaires were available in 86 patients (43 in the FFR versus 43 in the angiography-guided group). HRQoL was significantly improved and angina significantly decreased from baseline to 6 months after CABG with no difference between the randomization groups. Graft failure rates and clinical outcomes were similar in both groups. Patients with graft failure or FFR<0.80 of the previous deferred lesions had significantly lower visual analogue scale scores (78.7±14.2 versus 86.8±14.7, P=0.004) and more angina compared with patients without graft failure or FFR≥0.80 at 6-month follow-up.Conclusions:FFR- versus angiography-guided CABG demonstrated similar improvements in HRQoL and angina 6 months after CABG. Graft failure or low FFR in deferred lesions were associated with low HRQoL and angina.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02477371

中文翻译：

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血流储备分数与血管造影引导的冠状动脉旁路移植术中的健康相关生活质量和心绞痛：FARGO 试验（血流储备分数与血管造影随机化以进行移植优化）

背景：在冠状动脉旁路移植术 (CABG) 中，血流储备分数 (FFR) 的使用尚未得到充分研究。狭窄评估通常依赖于对病变严重程度的视觉估计。本研究评估了 FFR 引导的 CABG 与血管造影引导的 CABG 后的健康相关生活质量 (HRQoL) 和心绞痛。方法：将 100 名转诊进行 CABG 的患者随机分配至 FFR 或血管造影引导的 CABG。在 FFR 组中，FFR>0.80 的病变被推迟，而外科医生对血管造影组的 FFR 值不知情。CABG前和术后6个月，HRQoL通过EuroQoL 5级仪器的健康状态分类器EQ-5D进行评估，并注册基于加拿大心血管学会分类系统的心绞痛状态。 结果：6个月的血管造影包括FFR评估的延迟病变。总共，在 86 名患者中完成了 EuroQoL 5 级仪器问卷的 EQ-5D（FFR 为 43，血管造影指导组为 43）。从基线到 CABG 后 6 个月，HRQoL 显着改善，心绞痛显着减少，随机分组之间没有差异。两组的移植失败率和临床结果相似。移植失败或 FFR<0.80 的先前延迟病变患者的视觉模拟评分显着降低（78.7±14.2 对 86.8±14.7，两组的移植失败率和临床结果相似。移植失败或 FFR<0.80 的先前延迟病变患者的视觉模拟评分显着降低（78.7±14.2 对 86.8±14.7，两组的移植失败率和临床结果相似。移植失败或 FFR<0.80 的先前延迟病变患者的视觉模拟评分显着降低（78.7±14.2 对 86.8±14.7，P = 0.004) 并且在 6 个月的随访中与没有移植失败或 FFR ≥ 0.80 的患者相比，心绞痛更多。结论：在 CABG 后 6 个月，FFR 与血管造影引导的 CABG 在 HRQoL 和心绞痛方面的改善相似。延迟病变中的移植失败或低 FFR 与低 HRQoL 和心绞痛相关。Registration:URL: https://www.clinicaltrials.gov; 唯一标识符：NCT02477371