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Figure 1. Graffiti trial design. FFR: fractional flow reserve

mortality, readmission, and repeat revascularization all favored CABG across all major clinical subgroups.
CABG was angiography-guided and suggest that excellent outcomes that outperform PCI are achievable
without FFR guidance.

The FUTURE trial, which was presented by Rioufol and colleagues at European Society of Cardiology
Congress in Munich (Germany, 2018), was designed to explore the impact of FFR guided treatment
strategies in patients with angiographic multi-vessel coronary disease in 31 French centers. In the FFR-
guided group, FFR was performed on all target lesions, with FFR less than 0.80 regarded as eligible for
PCI or CABG. There planned enrolment of 1,728 patients was halted due to an observed difference in all-
cause mortality after 938 patients were randomized. The presenters highlighted three factors that could
have played a role in the higher rate of mortality in the FFR-guided group: the lower-than-expected rate of
CABG considering that all patients had multi-vessel disease, the higher rate of PCI in severe patients with
a SYNTAX score over 32, and the high rate of ad hoc PCI (about 90% in both groups).

POTENTIAL ALTERNATIVE MODALITIES THAT MAY IMPROVE CORONARY ARTERY BYPASS
GRAFTING PLANNING AND DECISION-MAKING
The rapid development in non-invasive imaging technology offers exciting potential alternatives to
conventional invasive coronary angiography. Computerised tomographic coronary angiography (CTCA) is