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

Doyeon Hwang
Doyeon Hwang1, MD; Joo Myung Lee2, MD, MPH, PhD; Hyun-Jong Lee3, MD, PhD; Su Hong Kim4, MD, PhD; Chang-Wook Nam5, MD, PhD; Joo-Yong Hahn2, MD, PhD; Eun-Seok Shin6,7, MD, PhD; Akiko Matsuo8, MD; Nobuhiro Tanaka9, MD, PhD; Hitoshi Matsuo10, MD, PhD; Sung Yun Lee11, MD, PhD; Joon-Hyung Doh12, MD, PhD; Bon-Kwon Koo1,12, MD, PhD
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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clinical researchdrug-eluting stentfractional flow reserve
Coronary interventionsSTEMINSTEMIStable CADOther coronary interventions
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