Coronary Pressure Measurement After Stenting Predicts Adverse Events at Follow-Up

Abstract

Background-Coronary stenting is associated with a restenosis rate of 15% to 20% at 6-month follow-up, despite optimum angiographic stent implantation. In this multicenter registry, we investigated the relation between optimum physiological stent implantation as assessed by poststent fractional flow reserve (FFR) and outcome at 6 months. Methods and Results-In 750 patients, coronary pressure measurement at maximum hyperemia was performed after angiographically apparently satisfactory stent implantation. Poststenting FFR was calculated and related to major adverse events (including need for repeat target vessel revascularization) at 6 months. In 76 patients (10.2%), at least 1 adverse event occurred. Five patients died, 19 experienced myocardial infarction, and 52 underwent at least 1 repeat target vessel revascularization. By multivariate analysis, FFR immediately after stenting was the most significant independent variable related to all types of events. In 36% of the patients, FFR normalized (Ͼ0.95), and event rate was 4.9% in that group. In 32% of the patients, poststent FFR was between 0.90 and 0.95, and event rate was 6.2%. In 32% of patients, poststent FFR was Ͻ0.90, and event rate was 20.3%. In 6% of the patients, FFR was Ͻ0.80, and event rate was 29.5% (PϽ0.001). Conclusions-FFR after stenting is a strong independent predictor of outcome at 6 months.

Relation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes

“…5,6 The poststent FFR detects a residual pressure gradient across the stented and adjacent segments that can play an important role in restenosis. 8,14 Although the validation of FFR for the purpose of the assessment of optimal bare metal stent deployment was reported, 5,8 to our knowledge, few reports on its use in the context of DESs have been published. In the present study, several intuitive findings were observed according to the FFR range after stent implantation.…”

“…[3][4][5][6][7] The fractional flow reserve (FFR) can identify a residual hyperemic pressure gradient that results in abnormal resistance across both the stented and the adjacent segments. Although the FFR measured after bare metal stent implantation correlated with the 6-month clinical outcomes in a previous study, 8 it is unknown whether the same applies to DES implantation. The aim of the present study was to investigate the relation between optimal physiologic DES implantation assessed by the poststent FFR and the outcomes at 1 year.…”

Coronary microvascular reactivity is only partially predicted by atherosclerosis risk factors or coronary artery disease in women evaluated for suspected ischemia: results from the NHLBI Women's Ischemia Syndrome Evaluation (WISE)

“…While similar doses of intracoronary Ado provide near-maximal increase in coronary flow in 90-92% of cases, 28 the 18 mcg dose may not have achieved maximal hyperemia in every patient. 29 Also, no systematic assessment of left ventricular hypertrophy was undertaken. Although this could influence CFVR Ado , an echocardiographic analysis from a WISE cohort suggested that limited CFVR Ado could not be explained by left ventricular hypertrophy.…”

Impact of Angiographic Residual Stenosis on Clinical Outcomes After New‐Generation Drug‐Eluting Stents Implantation: Insights From a Pooled Analysis of the RESET and NEXT Trials

“…However, it is important to note that an aggressive strategy targeting 0% residual stenosis is inevitably associated with higher risk for procedural complications such as dissection and/or perforation. Furthermore, the recommendation was based on the extrapolation from the findings in the studies using IVUS or fractional flow reserve 2, 3. Few studies have ever investigated the relationship between the angiographic residual stenosis and clinical outcomes in patients undergoing PCI using DES.…”

“…According to the latest American College of Cardiology/American Heart Association guidelines, the optimal minimum diameter stenosis <10% with an optimal goal of as close to 0% as possible was the new benchmark regardless of the types of stents, because many previous studies suggested inadequately deployed stents as the culprit of increased in‐stent restenosis (ISR) and stent thrombosis 1, 2, 3. Nevertheless, very few reports have investigated the relation between the poststenting angiographic result and clinical outcomes after implantation of drug‐eluting stents (DES), particularly new‐generation DES 4.…”