Pre‐stenting angiography‐FFR based physiological map provides virtual intervention and predicts physiological and clinical outcomes

Abstract

Background: Angiography-derived fractional flow reserve (FFR) (angio-FFR) has been validated against FFR and could provide virtual pullback. However, whether a physiological map can be generated by angio-FFR and its clinical value remains unclear. We aimed to investigate the feasibility of physiological map created from angio-FFR pullback and its value in predicting physiological and clinical outcomes after stenting.Methods: An angio-FFR physiological map was generated by overlaying the virtual pullback onto coronary angiogram, to calculate physiological stenosis severity, length, and intensity (Δangio-FFR/mm). This map in combination with virtual stenting was used to predict the best-case post-percutaneous coronary intervention (PCI) angio-FFR (angio-FFR predicted ) according to the stented segments, and this was compared with the actual achieved post-PCI angio-FFR (angio-FFR achieved ).Additionally, prognostic value of predicted angio-FFR was investigated.Results: Three hundred twenty-nine vessels with paired analyzable pre-and post-PCI angio-FFR were included. Physiological map was created successfully in all vessels. After successful PCI, angio-FFR predicted and angio-FFR achieved were significantly correlated (r = 0.82, p < 0.001) with small difference (mean difference: −0.010 ± 0.035). In the virtual PCI only covering the segment with high angio-FFR intensity, the same physiological outcome can be achieved with shorter stent length (14.1 ± 8.9 vs. 34.5 ± 15.8 mm, p < 0.001). Suboptimal angio-FFR predicted was associated with increased risk of 2-year vessel-oriented composite endpoint (adjusted hazard ratio: 3.71; 95% confidence interval: 1.50−9.17).Conclusions: Angio-FFR pullback could provide a physiological map of the interrogated coronary vessels by integrating angio-FFR pullback and angiography. Before a PCI, the physiological map can predict the physiological and clinical outcomes after stenting.

Coronary Angiography Upgraded by Imaging Post-Processing: Present and Future Directions

“…It allows us to generate ∆angio-FFR/mm, an equivalent of dQFR/dt index, and a flashangio caFFR-PBPG. These indexes have proven their feasibility for virtual PCI and their prognostic value [41]. This virtual PCI may be of particular interest in cases of tandem stenosis where FFR measurements may be compromised [55].…”