Impact of preoperative fractional flow reserve on arterial bypass graft anastomotic function: the IMPAG trial

David Glineur, Juan B. Grau, Pierre-Yves Etienne, Umberto Benedetto, et al.

Research output: Contribution to journalArticle (Academic Journal)peer-review

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AIMS:Visual estimation is the most commonly used method to evaluate the degree of coronary artery stenosis prior to coronary artery bypass grafting. In interventional cardiology, the use of fractional flow reserve (FFR) to guide revascularization decisions has become routine. We investigated whether the preoperative FFR measurement of coronary lesions is associated with anastomosis function 6 months after surgical revascularization using a multiarterial grafting strategy.
METHODS AND RESULTS:In this prospective double-blind study, 67 patients were enrolled from two institutions in Europe and Canada. From these patients, 199 coronary lesions were assessed visually and with FFR at the time of the preoperative angiogram. All patients received coronary revascularization using multiple arterial grafts. A post-operative 6-month angiogram was performed to assess anastomosis functionality using a described angiographic method. The primary outcome was the association between preoperative FFR values and anastomosis function 6 months after surgery. Preoperative FFR was significantly associated with 6-months anastomotic function for all conduits and for all targets (P  <  0.001). An FFR value of ≤0.78 was associated with an anastomotic occlusion rate of 3%.

CONCLUSION:We found a significant association between the preoperative FFR measurement of the target vessel and the anastomotic functionality at 6 months, with a cut-off of 0.78. Integration of FFR measurement into the preoperative diagnostic workup before multiarterial coronary surgical revascularization leads to improved anastomotic graft function.
Original languageEnglish
Article numberehz329
Pages (from-to)2421-2428
Number of pages8
JournalEuropean Heart Journal
Issue number29
Early online date1 Jun 2019
Publication statusPublished - 1 Aug 2019


  • FFR
  • CABG
  • arterial graft
  • flow competition


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