Joo Myung Lee1, Doyeon Hwang2, Ki Hong Choi1, Tae-Min Rhee2, Jonghanne Park2, Hyung Yoon Kim3, Hae Won Jung4, Ji-Won Hwang5, Hyun-Jong Lee6, Ho-Jun Jang6, Su Hong Kim7, Young Bin Song1, Yun-Kyeong Cho8, Chang-Wook Nam8, Joo-Yong Hahn1, Eun-Seok Shin9, Yoshiaki Kawase10, Akiko Matsuo11, Nobuhiro Tanaka12, Joon-Hyung Doh13, Bon-Kwon Koo14, Hitoshi Matsuo10. 1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea. 3. Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea. 4. Department of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea. 5. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. 6. Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea. 7. Department of Cardiology, Busan Veterans Hospital, Busan, Korea. 8. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea. 9. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea; Division of Cardiology, Ulsan Hospital, Ulsan, Korea. 10. Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan. 11. Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoko, Japan. 12. Department of Cardiology, Tokyo Medical University, Tokyo, Japan. 13. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. Electronic address: joon.doh@gmail.com. 14. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Institute on Aging, Seoul National University, Seoul, Korea. Electronic address: bkkoo@snu.ac.kr.
Abstract
OBJECTIVES: The study sought to investigate the prognostic implications of relative increase of fractional flow reserve (FFR) with PCI in combination with post-percutaneous coronary intervention (PCI) FFR. BACKGROUND: FFR, measured after PCI has been shown to possess prognostic implications. The relative increase of FFR with PCI can be determined by the interaction of baseline disease pattern, adequacy of PCI, and residual disease burden in a target vessel. However, the role of relative increase of FFR with PCI has not yet been evaluated. METHODS: A total of 621 patients who underwent PCI using second-generation drug-eluting stents based on low pre-PCI FFR (≤0.80) and available post-PCI FFR were analyzed. The relative increase of FFR was calculated by %FFR increase with PCI ([post-PCI FFR - pre-PCI FFR]/pre-PCI FFR × 100). Patients were divided according to the optimal cutoff values of post-PCI FFR (<0.84) and %FFR increase (≤15%). The primary outcome was target vessel failure (TVF) (a composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target vessel revascularization) at 2 years. RESULTS: Among the total population, 66.0% showed high post-PCI FFR (≥0.84) and 69.2% showed high %FFR increase (>15%). Patients with low post-PCI FFR showed a higher risk of 2-year TVF than did those with high post-PCI FFR (9.1% vs. 2.6%; hazard ratio [HR]: 3.367; 95% confidence interval [CI]: 1.412 to 8.025; p = 0.006). Patients with low %FFR increase also showed a higher risk of 2-year TVF compared with those with high %FFR increase (9.2% vs. 3.0%; HR: 3.613; 95% CI: 1.543 to 8.458; p = 0.003). Among the high post-PCI FFR group, there were no significant differences in clinical outcomes according to %FFR increase. Conversely, among the low post-PCI FFR group, those with low %FFR increase showed a significantly higher risk of TVF than did those with high %FFR increase (14.3% vs. 4.1%; HR: 4.334; 95% CI: 1.205 to 15.594; p = 0.025). Percent FFR increase significantly increased discriminant and reclassification ability for the occurrence of TVF when added to a model with clinical risk factors and post-PCI FFR (C-index 0.783 vs. 0.734; relative integrated discrimination improvement 0.702; p = 0.009; category-free net reclassification index 0.479; p = 0.031). CONCLUSIONS: Percent FFR increase with PCI showed similar prognostic implications with post-PCI FFR. Adding the relative increase of FFR to post-PCI FFR would enable better discrimination of high-risk patients after stent implantation. (Influence of FFR on the Clinical Outcome After Percutaneous Coronary Intervention [PERSPECTIVE]; NCT01873560).
OBJECTIVES: The study sought to investigate the prognostic implications of relative increase of fractional flow reserve (FFR) with PCI in combination with post-percutaneous coronary intervention (PCI) FFR. BACKGROUND: FFR, measured after PCI has been shown to possess prognostic implications. The relative increase of FFR with PCI can be determined by the interaction of baseline disease pattern, adequacy of PCI, and residual disease burden in a target vessel. However, the role of relative increase of FFR with PCI has not yet been evaluated. METHODS: A total of 621 patients who underwent PCI using second-generation drug-eluting stents based on low pre-PCI FFR (≤0.80) and available post-PCI FFR were analyzed. The relative increase of FFR was calculated by %FFR increase with PCI ([post-PCI FFR - pre-PCI FFR]/pre-PCI FFR × 100). Patients were divided according to the optimal cutoff values of post-PCI FFR (<0.84) and %FFR increase (≤15%). The primary outcome was target vessel failure (TVF) (a composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target vessel revascularization) at 2 years. RESULTS: Among the total population, 66.0% showed high post-PCI FFR (≥0.84) and 69.2% showed high %FFR increase (>15%). Patients with low post-PCI FFR showed a higher risk of 2-year TVF than did those with high post-PCI FFR (9.1% vs. 2.6%; hazard ratio [HR]: 3.367; 95% confidence interval [CI]: 1.412 to 8.025; p = 0.006). Patients with low %FFR increase also showed a higher risk of 2-year TVF compared with those with high %FFR increase (9.2% vs. 3.0%; HR: 3.613; 95% CI: 1.543 to 8.458; p = 0.003). Among the high post-PCI FFR group, there were no significant differences in clinical outcomes according to %FFR increase. Conversely, among the low post-PCI FFR group, those with low %FFR increase showed a significantly higher risk of TVF than did those with high %FFR increase (14.3% vs. 4.1%; HR: 4.334; 95% CI: 1.205 to 15.594; p = 0.025). Percent FFR increase significantly increased discriminant and reclassification ability for the occurrence of TVF when added to a model with clinical risk factors and post-PCI FFR (C-index 0.783 vs. 0.734; relative integrated discrimination improvement 0.702; p = 0.009; category-free net reclassification index 0.479; p = 0.031). CONCLUSIONS: Percent FFR increase with PCI showed similar prognostic implications with post-PCI FFR. Adding the relative increase of FFR to post-PCI FFR would enable better discrimination of high-risk patients after stent implantation. (Influence of FFR on the Clinical Outcome After Percutaneous Coronary Intervention [PERSPECTIVE]; NCT01873560).
Authors: Roberto Diletti; Kaneshka Masdjedi; Joost Daemen; Laurens J C van Zandvoort; Tara Neleman; Jeroen Wilschut; Wijnand K Den Dekker; Rutger J van Bommel; Miguel Lemmert; Isabella Kardys; Paul Cummins; Peter de Jaegere; Felix Zijlstra; Nicolas M Van Mieghem Journal: Circ Cardiovasc Interv Date: 2021-03-09 Impact factor: 6.546
Authors: Michiel J Bom; Stefan P Schumacher; Roel S Driessen; Pepijn A van Diemen; Henk Everaars; Ruben W de Winter; Peter M van de Ven; Albert C van Rossum; Ralf W Sprengers; Niels J W Verouden; Alexander Nap; Maksymilian P Opolski; Jonathon A Leipsic; Ibrahim Danad; Charles A Taylor; Paul Knaapen Journal: Catheter Cardiovasc Interv Date: 2020-08-26 Impact factor: 2.692