Tsuyoshi Ito1, Tomomitsu Tani2, Hiroshi Fujita2, Nobuyuki Ohte2. 1. Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: tuyosiito@gmail.com. 2. Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Abstract
BACKGROUND: The underlying cause of FFR reduction and prognostic impact of FFR after optimal DES implantation remain unknown. The study aims were to use intravascular ultrasound (IVUS) to investigate the mechanism responsible for reduced fractional flow reserve (FFR) after optimal drug-eluting stent (DES) implantation and to evaluate FFR effect on clinical outcomes after optimal percutaneous coronary intervention with DES. METHODS: Ninety-seven patients treated with optimal DES implantation under IVUS and pullback FFR guidance were followed clinically (median 17.8 months). Post-stenting IVUS examination and pullback FFR recording were performed, and angiographic and IVUS parameters associated with reduced FFR were evaluated. The composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization, was analyzed. RESULTS: Regression analysis showed inverse correlations between post-stent FFR and residual plaque volume index (r=-0.40, p<0.01) and residual percent plaque volume (r=-0.68, p<0.01) in IVUS but no correlation of minimal lesion diameter with quantitative coronary angiography (r=0.07, p=0.50) or IVUS-derived minimal stent area (r=0.02, p=0.84). MACE was observed in 10 patients (10.3%), and FFR after optimal stenting was significantly lower in this group (0.86 ± 0.04 vs 0.91 ± 0.04, p<0.01). The optimal FFR threshold for predicting MACE was 0.90, identified by the receiver operating characteristic curve. CONCLUSIONS: Reduced FFR after optimal DES implantation was associated with residual plaque volume identified by IVUS and future adverse cardiac events.
BACKGROUND: The underlying cause of FFR reduction and prognostic impact of FFR after optimal DES implantation remain unknown. The study aims were to use intravascular ultrasound (IVUS) to investigate the mechanism responsible for reduced fractional flow reserve (FFR) after optimal drug-eluting stent (DES) implantation and to evaluate FFR effect on clinical outcomes after optimal percutaneous coronary intervention with DES. METHODS: Ninety-seven patients treated with optimal DES implantation under IVUS and pullback FFR guidance were followed clinically (median 17.8 months). Post-stenting IVUS examination and pullback FFR recording were performed, and angiographic and IVUS parameters associated with reduced FFR were evaluated. The composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization, was analyzed. RESULTS: Regression analysis showed inverse correlations between post-stent FFR and residual plaque volume index (r=-0.40, p<0.01) and residual percent plaque volume (r=-0.68, p<0.01) in IVUS but no correlation of minimal lesion diameter with quantitative coronary angiography (r=0.07, p=0.50) or IVUS-derived minimal stent area (r=0.02, p=0.84). MACE was observed in 10 patients (10.3%), and FFR after optimal stenting was significantly lower in this group (0.86 ± 0.04 vs 0.91 ± 0.04, p<0.01). The optimal FFR threshold for predicting MACE was 0.90, identified by the receiver operating characteristic curve. CONCLUSIONS: Reduced FFR after optimal DES implantation was associated with residual plaque volume identified by IVUS and future adverse cardiac events.
Authors: Mathias Wolfrum; Gregor Fahrni; Giovanni Luigi de Maria; Guido Knapp; Nick Curzen; Rajesh K Kharbanda; Georg M Fröhlich; Adrian P Banning Journal: BMC Cardiovasc Disord Date: 2016-09-08 Impact factor: 2.298
Authors: Damien Collison; Matthaios Didagelos; Muhammad Aetesam-Ur-Rahman; Samuel Copt; Robert McDade; Peter McCartney; Thomas J Ford; John McClure; Mitchell Lindsay; Aadil Shaukat; Paul Rocchiccioli; Richard Brogan; Stuart Watkins; Margaret McEntegart; Richard Good; Keith Robertson; Patrick O'Boyle; Andrew Davie; Adnan Khan; Stuart Hood; Hany Eteiba; Colin Berry; Keith G Oldroyd Journal: Eur Heart J Date: 2021-12-01 Impact factor: 29.983