Times of India
13 February, 2010
Kounteya Sinha
New Delhi, India

The number of unnecessary or premature angioplasty and bypass surgeries to unclog coronary arteries could finally see a dip in India. Cardiologists are all set to maximise the use of fractional flow reserve (FFR) – a procedure in which a wire is inserted into the arteries to accurately measure blood pressure and flow to the heart and determine if the blockage could ultimately lead to ischemia.

Experts say FFR will prove to be a boon especially for patients suffering from multiple blockages of heart vessels. With FFR, cardiologists will be able to quantify the risk of a particular blockage and decide whether to conduct an angioplasty or bypass or simply treat it with medicines.

At present, cardiologists use their experience to decide which blockage would require intervention. Hence, in many cases, people with chest pain undergo an angioplasty even when they don’t require it as drugs could prove just as effective.

Dr Praveen Chandra, chairman of interventional cardiology at Medanta Medicity, who is going to use FFR on a 78–year–old patient with multiple coronary blocks on Saturday, said the measurement of FFR has been shown to be highly accurate in assessing whether or not to perform angioplasty or stenting on intermediate blockages.

“Blockages in the coronary arteries are opened up to increase blood flow to the heart. But FFR can quantify the obstruction. If it says that the blood flow is not significantly obstructed, the blockage does not need to be revascularised (angioplasty) and the patient can be treated safely with medical therapy. When FFR is below .75, then angioplasty would be required,” Dr Chandra said.

According to chairman and chief cardiologist of Escorts Heart Research Centre, Dr Ashok Seth, India at present sees over 1.2 lakh angioplasties being conducted annually and over a lakh bypass surgeries. “This number could come down with the help of FFR. Though using FFR will cost a patient an additional Rs 25,000, it would still be cheaper than paying for a notso–needed angioplasty or bypass,” said Dr Seth who is training 200 interventional trainee cardiologists on FFR at Escorts on February 24.

Experts say a recent largescale study on 2,000 patients in US and Europe showed that one–third fewer stents were used in the FFR group and the difference in outcomes at one year were significant: the FFR group showed a 28% lower incidence of major adverse cardiac events – 18.3% vs 13.2%. Another benefit seen in the FFR group was procedural cost. Since less stents were used per patient, the average cost of the procedure was $700 lower.

“Angioplasty is used too often, and in many cases, the modest benefits don’t justify the procedure’s cost. FFR will soon become an integral part of every interventional procedure in India,” an expert said. Cardiologists admit that because sometimes they can’t discriminate by angiogram which lesions are causing ischemia, they “place stents everywhere that look risky” and the benefits of placing the stent in the right position is countered by the damage they do by placing stents where it is not necessary.