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

Coronary interventions

Influence of target vessel on prognostic relevance of fractional flow reserve after coronary stenting

EuroIntervention 2019;15:457-464. DOI: 10.4244/EIJ-D-18-00913

1. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea; 2. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 3. Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea; 4. Department of Cardiology, Busan Veterans Hospital, Busan, Republic of Korea; 5. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea; 6. Division of Cardiology, Ulsan Medical Center, Ulsan, Republic of Korea; 7. Department of Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; 8. Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan; 9. Department of Cardiology, Tokyo Medical University, Tokyo, Japan; 10. Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan; 11. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; 12. Institute of Aging, Seoul National University, Seoul, Republic of Korea

Aims: We sought to investigate the influence of the target vessel on the prognostic relevance of fractional flow reserve (FFR) after percutaneous coronary intervention (PCI).

Methods and results: A total of 835 patients with available FFR after second-generation drug-eluting stent (DES) implantation were included in this study. The primary outcome was target-vessel failure (TVF), including cardiac death, target vessel-related myocardial infarction, and clinically driven target vessel revascularisation. The target vessel was the left anterior descending artery (LAD) in 603 patients (72.2%) and non-LAD in 232 patients (27.8%). The distribution pattern of post-PCI FFR values was different between the LAD and non-LAD (p<0.001). The optimal cut-off values of post-PCI FFR for predicting TVF were 0.82 and 0.88 in the LAD and non-LAD, respectively. The cumulative incidence of TVF was significantly higher in patients with lower post-PCI FFR than each cut-off value (10.9% vs. 2.5%, hazard ratio [HR] 4.08, 95% confidence interval [CI]: 2.63-6.34, p<0.001 in LAD; 8.0% vs. 1.9%, HR 6.00, 95% CI: 1.78-20.26, p=0.004 in non-LAD).

Conclusions: Higher post-PCI FFR after second-generation DES implantation was associated with better clinical outcomes. Different cut-off values of post-PCI FFR need to be applied according to the target vessel. ClinicalTrials Identifier: NCT01873560

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