Shiv K Agarwal1, Srikanth Kasula1, Yalcin Hacioglu1, Zubair Ahmed2, Barry F Uretsky2, Abdul Hakeem3. 1. Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 2. Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Cardiology Section, Central Arkansas Veteran Affairs Health System, Little Rock, Arkansas. 3. Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Cardiology Section, Central Arkansas Veteran Affairs Health System, Little Rock, Arkansas. Electronic address: ahakeem@gmail.com.
Abstract
OBJECTIVES: This study sought to evaluate the impact of fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) on subsequent in-lab interventional management vessels that had undergone pre-PCI FFR and its prognostic value in predicting long-term (>1 year) outcomes. BACKGROUND: Post-PCI FFR has been shown to be a predictor of intermediate-term (6 months) adverse events. However, its impact on immediate post procedure clinical decision making and long-term outcomes is not known. METHODS: Consecutive patients undergoing PCI who had pre- and post-PCI FFR evaluations were followed for major adverse cardiovascular events (MACE). RESULTS: In the study 574 patients (664 lesions) were followed for 31 ± 16 months. PCI led to significant improvement in FFR from 0.65 ± 0.14 to 0.87 ± 0.08 (p < 0.0001). Despite satisfactory angiographic appearance, 143 lesions (21%) demonstrated post-PCI FFR in the ischemic range (FFR ≤0.81). After subsequent interventions, FFR in this subgroup increased from 0.78 ± 0.08 to 0.87 ± 0.06 (p < 0.0001). Final FFR cutoff of ≤0.86 had the best predictive accuracy for MACE and ≤0.85 for TVR. Patients who achieved final FFR >0.86 had significantly lower MACE compared to the final FFR ≤0.86 group (17% vs. 23%; log-rank p = 0.02). Final FFR ≤0.86 had incremental prognostic value over clinical and angiographic variables for MACE prediction. CONCLUSIONS: Post-PCI FFR reclassified 20% of angiographically satisfactory lesions, which required further intervention thereby providing an opportunity for complete functional optimization at the time of the index procedure. This is particularly important as FFR post-PCI FFR was a powerful independent predictor of long-term outcomes.
OBJECTIVES: This study sought to evaluate the impact of fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) on subsequent in-lab interventional management vessels that had undergone pre-PCI FFR and its prognostic value in predicting long-term (>1 year) outcomes. BACKGROUND: Post-PCI FFR has been shown to be a predictor of intermediate-term (6 months) adverse events. However, its impact on immediate post procedure clinical decision making and long-term outcomes is not known. METHODS: Consecutive patients undergoing PCI who had pre- and post-PCI FFR evaluations were followed for major adverse cardiovascular events (MACE). RESULTS: In the study 574 patients (664 lesions) were followed for 31 ± 16 months. PCI led to significant improvement in FFR from 0.65 ± 0.14 to 0.87 ± 0.08 (p < 0.0001). Despite satisfactory angiographic appearance, 143 lesions (21%) demonstrated post-PCI FFR in the ischemic range (FFR ≤0.81). After subsequent interventions, FFR in this subgroup increased from 0.78 ± 0.08 to 0.87 ± 0.06 (p < 0.0001). Final FFR cutoff of ≤0.86 had the best predictive accuracy for MACE and ≤0.85 for TVR. Patients who achieved final FFR >0.86 had significantly lower MACE compared to the final FFR ≤0.86 group (17% vs. 23%; log-rank p = 0.02). Final FFR ≤0.86 had incremental prognostic value over clinical and angiographic variables for MACE prediction. CONCLUSIONS: Post-PCI FFR reclassified 20% of angiographically satisfactory lesions, which required further intervention thereby providing an opportunity for complete functional optimization at the time of the index procedure. This is particularly important as FFR post-PCI FFR was a powerful independent predictor of long-term outcomes.
Authors: K Masdjedi; L J C van Zandvoort; T Neleman; I Kardys; J Ligthart; W K Den Dekker; R Diletti; F Zijlstra; N M Van Mieghem; J Daemen Journal: Neth Heart J Date: 2022-04-07 Impact factor: 2.854
Authors: Antonio Maria Leone; Francesco Burzotta; Cristina Aurigemma; Giovanni Luigi De Maria; Aniello Zambrano; Giuseppe Zimbardo; Manfredi Arioti; Emma Cerracchio; Rocco Vergallo; Carlo Trani; Filippo Crea Journal: J Am Heart Assoc Date: 2019-07-23 Impact factor: 5.501