Clinical Implications of Fractional Flow Reserve Measured Immediately After Percutaneous Coronary Intervention

Abstract

Purpose The purpose of the present study was to find the independent predictors of Fractional Flow Reserve (FFR) measured immediately after percutaneous coronary intervention with drug-eluting stent implantation (post-PCI FFR) and investigate if applying vessel-specific post-PCI FFR cut-off values to predict target vessel failure (TVF), a composite of cardiac death (CD), non-fatal myocardial infarction (MI) and target vessel revascularization (TVR), or a composite of CD and MI ameliorated its predictive power. Methods Consecutive patients with post-PCI FFR measurement at our center between 2009 and 2021 were included in this analysis. Results A total of 434 patients with 500 vessels were included. Median pre-PCI FFR was 0.72 with no difference between LAD and non-LAD vessels. Median post-PCI FFR was 0.87. LAD location, male gender, smaller stent diameter, and lower pre-PCI FFR proved to be significant predictors of a lower post-PCI FFR. On a vessel-level, post-PCI FFR, stent length, and diabetes mellitus proved to be significant predictors of TVF and the composite of CD and MI. The best post-PCI FFR cut-off to predict TVF or a composite of CD and MI was 0.83 in the LAD and 0.91 in non-LAD vessels. Conclusion LAD location is a predictor of a lower post-PCI FFR. Post-PCI FFR is an independent predictor of TVF as well as of the composite of CD and MI. No uniform target post-PCI FFR value exists; different cut-off values may have to be applied in LAD as opposed to non-LAD vessels.

Prognostic value of optical flow ratio for cardiovascular outcomes in patients after percutaneous coronary stent implantation

“…The possible reason is that stent underexpansion and residual lesions are significantly correlated with pressure drop, both of which may result in low physiological function value and lead to poor prognosis ( 9 , 33 ). Therefore, in conjunction with luminal imaging-guided stent optimization, post-PCI OFR can provide insight into the potential benefit of additional PCI strategies in improving clinical outcomes ( 34 , 35 ). Previous research has indicated a direct correlation between low post-PCI FFR and future adverse cardiac events ( 34 ).…”

“…Therefore, in conjunction with luminal imaging-guided stent optimization, post-PCI OFR can provide insight into the potential benefit of additional PCI strategies in improving clinical outcomes ( 34 , 35 ). Previous research has indicated a direct correlation between low post-PCI FFR and future adverse cardiac events ( 34 ). The specific cutoff value for post-PCI FFR may vary depending on factors such as the target lesion, vessel, and characteristics of the patients included in each study.…”