Physiology-guided CABG: Is it Time for Cardiac Surgeons to Incorporate FFR Into Their Practice?

According to most recent international guidelines on myocardial revascularization, fractional flow reserve (FFR)-guided percutaneous coronary intervention should be considered in patients with multivessel disease. That would include evaluation of all lesions between 40 to 90% diameter stenosis before implanting a stent.^, The same guidelines suggest prioritizing completeness of revascularization when the decision is made for coronary artery bypass graft surgery (CABG), which means bypassing all lesions >50% diameter stenosis.

In this issue of Arquivos Brasileiros de Cardiologia, Martins et al., approached this paradox with a meta-analysis of five studies and 1,114 patients, comparing physiology-guided CABG and conventional angiography-guided CABG. Although the pooled meta-analysis showed no difference in myocardial infarction and target vessel revascularization rates, a 37% relative risk reduction in all-cause death was associated with physiology-guided CABG.

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