The Value of Pre- and Post-Stenting Fractional Flow Reserve for Predicting Mid-Term Stent Restenosis Following Percutaneous Coronary Intervention (PCI)

Abstract

Measuring fractional flow reserve (FFR) in percutaneous coronary intervention (PCI) has predictive value for PCI outcome. We decided to examine the utility of pre- and post-stenting FFR as a predictor of 6-month stent restenosis as well as MACE (major adverse cardiac events). Pre- and post-stenting FFR values were measured for 60 PCI patients. Within 6 months after stenting, all patients were followed for assessment of cardiac MACE including myocardial infarction, unstable angina, or positive exercise test. Stent restenosis was also assessed. Cut-off values for pre- and post-stenting FFR measurements were considered respectively as 0.65 and 0.92. Stent restenosis was detected in 4 patients (6.6%). All 4 patients (100%) with restenosis had pre-stenting FFR of < 0.65, while only 26 of 56 patients without restenosis (46.4%) had pre-stenting FFR value of < 0.65 (P = 0.039). Mean pre-stenting FFR in patients with restenosis was significantly lower than in those without restenosis (0.25 ± 0.01 vs. 0.53 ± 0.03, P = 0.022). Although stent restenosis was higher in patients with post-stenting FFR of < 0.92 (2 cases, 9.5%) than in those with FFR value of ≥ 0.92 (2 cases, 5.1%), the difference was not statistically (P = 0.510). Pre-stenting FFR, the use of longer stents, and history of diabetes mellitus can predict stent restenosis, but the value of post-stenting FFR for predicting restenosis was not explicit.

Diabetes Mellitus as the Main Factor of Restenosis: Literature Review

“…The tendency for the incidence of MI was more in patients with insulin. From another point of view that has similarities to DM as an independent factor for restenosis, observations were made (Rai et al, 2015). Regarding the FFR, it was suggested that the post-stent FFR could be used to predict restenosis.…”

A randomized controlled trial of a physiology‐guided percutaneous coronary intervention optimization strategy: Rationale and design of the TARGET FFR study

“…Published values for overall mean or median final post‐PCI FFR results range from 0.84 to 0.95 . The proportion of patients actually achieving a final FFR ≥0.90 varies widely between studies and ranges from 37% to 93% .…”