The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Clinical outcomes of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention By Coronary Flow Capacity Status in Stable Lesions

DOI: 10.4244/EIJ-D-20-00401

1. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan; Harvard T.H. Chan School of Public Health, Boston, MA, USA
2. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
3. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan, Japan
4. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
5. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Institute on Aging, Seoul National University, Seoul, Korea
6. Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain; Centro Nacional de Investigaciónes Cardiovasculares Carlos III (CNIC), Madrid, Spain
7. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
8. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Naju National Hospital, Ministry of Health and Welfare, Naju, Korea
9. Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
10. Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
11. Department of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea
12. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
13. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
14. Division of Cardiology, Ulsan Hospital, Ulsan, Korea and Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
15. Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
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Aims: To investigate the effect of percutaneous coronary intervention (PCI) on vessel-related major adverse cardiovascular events (MACE) according to coronary flow capacity (CFC) status in stable coronary lesions.

Methods and results: From a global, multicenter registry of comprehensive physiological assessment, a total of 1397 patients (1694 vessels) were analyzed. Low CFC was defined for lesions with low coronary flow reserve (CFR) and low inverse of hyperemic mean transit time (1/hTmn). Pre-defined definition of CFC was assessed first in a multivariable marginal COX proportional model with the interaction term between CFC status and PCI (performed or not), and then the optimal definition of CFC was explored. The p-value for the interaction between pre-defined low CFC and PCI was 0.067. Next, we computed the optimal definition of CFC to maximize the interaction, where HR of PCI was 0.278 (95% CI: 0.103–0751) and 1.393 (95% CI: 0.783–2.478) for lesions low and normal CFC, respectively.

Conclusions: FFR-guided PCI was associated with reduced incidence of MACE in low CFC but not in normal CFC lesions. CFC information may be leveraged in combination with FFR for optimizing the indication for PCI by reducing potentially unbeneficial PCI.

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