Clinical and prognostic value of poststenting fractional flow reserve in acute coronary syndromes

Kasula, Srikanth; Agarwal, Shiv Kumar; Hacıoğlu, Yalçın; Pothineni, Nagavenkata Krishnachand; Bhatti, Sabha; Ahmed, Zubair; Uretsky, Barry F.; Hakeem, Abdul

doi:10.1136/heartjnl-2016-309422

Cited by 37 publications

(24 citation statements)

References 23 publications

(15 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the chronic phase, OCT and IVUS were performed and found no residual thrombus and no trace of plaque rupture within the CAE segment. Doppler velocimetry was also performed and found abnormal stagnant only within the ectasic coronary artery as shown in Figure 3D, although FFR was 1.0, which indicated there was no functional ischemia [10]. These findings confirmed that CAE was the most probably source of recurrent coronary thrombosis in this case.…”

Section: Discussionsupporting

confidence: 58%

Recurrent Acute Myocardial Infarction in a Patient with Severe Coronary Artery Ectasia: Implication of Antithrombotic Therapy

et al. 2016

View full text Add to dashboard Cite

Patient: Female, 78Final Diagnosis: Acute myocardial infarctionSymptoms: Chest discomfortMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Unusual clinical courseBackground:Acute myocardial infarction (AMI) can be caused not only by plaque rupture/erosion, but also by many other mechanisms. Thromboembolism due to atrial fibrillation and coronary thrombosis due to coronary artery ectasia are among the causes. Here we report on a case of recurrent myocardial infarction with coronary artery ectasia.Case Report:Our case was a 78-year-old woman with hypertension. Within a one-month interval, she developed AMI twice at the distal portion of her right coronary artery along with coronary artery ectasia. On both events, emergent coronary angiography showed no obvious organic stenosis or trace of plaque rupture at the culprit segment after thrombus aspiration. After the second acute event, we started anticoagulation therapy with warfarin to prevent thrombus formation. In the chronic phase, we confirmed, by using coronary angiography, optimal coherence tomography and intravascular ultrasound, that there was no plaque rupture and no obvious thrombus formation along the coronary artery ectasia segment of the distal right coronary artery, which suggested effectiveness of anticoagulant. Furthermore, by Doppler velocimetry we found sluggish blood flow only in the coronary artery ectasia lesion but not in the left atrium which is generally the main site of systemic thromboembolism revealed by transesophageal echocardiography.Conclusions:These results suggest that the two AMI events at the same coronary artery ectasia segment were caused by local thrombus formation due to local stagnant blood flow.Although it has not yet been generally established, anticoagulation therapy may be effective to prevent thrombus formation in patients with coronary artery ectasia regardless of the prevalence of atrial fibrillation.

show abstract

Section: Discussionsupporting

confidence: 58%

Recurrent Acute Myocardial Infarction in a Patient with Severe Coronary Artery Ectasia: Implication of Antithrombotic Therapy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…I read with great interest the article by Kasula et al 1, and I firmly believe that this is a novel finding and of great clinical significance.…”

mentioning

confidence: 76%

Inverse prognostic value of post-percutaneous coronary intervention fractional flow reserve in patients with non-ST segment elevation myocardial infarction

Nadir

2017

Heart

View full text Add to dashboard Cite

“…From a registry of 750 patients receiving bare metal stents, Pijls et al reported that at 6‐month follow‐up, the lowest event rates occurred in patients with post‐PCI FFR ≥0.90 . Studies and related meta‐analyses involving drug‐eluting stents have suggested similar cutoff values of post‐PCI FFR to predict improved clinical outcomes . These range from 0.89 to ≥0.92 with a large systematic review and meta‐analysis of 7470 patients concluding that a post‐PCI FFR ≥0.90 was associated with a significantly lower risk of repeat PCI and major adverse cardiovascular events .…”

Section: Introductionmentioning

confidence: 99%

“…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% .…”

Section: Introductionmentioning

confidence: 99%

“…Of perhaps greater concern however, is the incidence of suboptimal FFR results after stenting. Where reported, the proportion of patients with post‐PCI FFR values ≤0.80 ranges from 4% to 20% . This indicates that, despite angiographically satisfactory results, as many as one in five patients may have a post‐PCI FFR result that remains below the threshold for performing revascularization in the first place.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Collison

McClure

Berry

et al. 2020

Clinical Cardiology

View full text Add to dashboard Cite

Post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) ≥0.90 confers an improved cardiac prognosis. There are currently limited data available to determine how often it is possible to improve an angiographically acceptable but physiologically suboptimal result. A physiology-guided optimization strategy can achieve a clinically meaningful increase in the proportion of patients achieving a final post-PCI FFR ≥0.90 compared to standard care. Following angiographically successful PCI procedures, 260 patients will be randomized (1:1) to receive either a physiologyguided incremental optimization strategy (intervention group) or blinded post-PCI coronary physiology measurements (control group). Patients undergoing successful, standard-of-care PCI for either stable angina or non-ST-segment-elevation myocardial infarction who meet the study's inclusion and exclusion criteria will be eligible for randomization. The primary endpoint is defined as the proportion of patients with a final post-PCI FFR result ≥0.90. Secondary endpoints include change from baseline in Seattle Angina Questionnaire and EQ-5D-5L scores at 3 months and the rate of target vessel failure and its components (cardiac death, myocardial infarction, stent thrombosis, unplanned rehospitalization with target vessel revascularization) at 3 months and 1 year. 260 individual patients were successfully randomized between March 2018 and November 2019. Key baseline demographics of the study population are reported within. TARGET FFR is an investigator-initiated, prospective, single-center, randomized controlled trial of an FFR-guided PCI optimization strategy. The study has completed recruitment and is now in clinical follow-up. It is anticipated that primary results will be presented in Autumn 2020. ClinicalTrials.gov Identifier: NCT03259815. [Correction added on Apr 3 2020, after first online publication: Clinical Trials identifier added.]Abbreviations: CFR, coronary flow reserve; dPR, diastolic pressure ratio; FFR, fractional flow reserve; HTG, hyperemic tran-stent gradient; IC, intracoronary; iFR, instantaneous wave-free ratio; IMR, index of microcirculatory resistance; ISR, in-stent restenosis; IVUS, intravascular ultrasound; MACE, major adverse cardiovascular events; NSTEMI, non-ST segment elevation myocardial infarction; OCT, optical coherence tomography; PCI, percutaneous coronary intervention; Pd/Pa, distal coronary pressure/aortic pressure; PIOS, physiologically guided incremental optimization strategy; RFR, resting full-cycle ratio; SAQ, Seattle Angina Questionnaire; STEMI, ST-segment elevation myocardial infarction; TT hyp , mean hyperemic transit time; TT rest , mean resting transit time.

show abstract

Clinical and prognostic value of poststenting fractional flow reserve in acute coronary syndromes

Abstract: Post-PCI FFR is valuable in assessing the functional outcome of PCI in patients with ACS. Use of post-PCI FFR in patients with ACS allows for functional optimisation of PCI results and is predictive of long-term outcomes in patients with ACS.

Cited by 37 publications

References 23 publications

Recurrent Acute Myocardial Infarction in a Patient with Severe Coronary Artery Ectasia: Implication of Antithrombotic Therapy

Recurrent Acute Myocardial Infarction in a Patient with Severe Coronary Artery Ectasia: Implication of Antithrombotic Therapy

Inverse prognostic value of post-percutaneous coronary intervention fractional flow reserve in patients with non-ST segment elevation myocardial infarction

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

Contact Info

Product

Resources

About