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

Nam, Chang Wook; Hur, Seung‐Ho; Cho, Yun–Kyeong; Park, Hyoung Seob; Yoon, Hyuck Jun; Kim, Hyungseop; Chung, In-Sung; Kim, Yoon Nyun; Kim, Kwon Bae; Doh, Joon Hyung; Koo, Bon‐Kwon; Tahk, Seung Jea; Fearon, William F.

doi:10.1016/j.amjcard.2011.02.329

Cited by 80 publications

(55 citation statements)

References 17 publications

(24 reference statements)

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“…Actually, the present study provided a sufficiently high FFR ([0.90) immediately after PCI in 63 (37.7 %) among 167 patients, an achievement rate lower than 50.0 % reported by Num et al [8] in Korea, and indicated insufficiently improved FFR in 31 (18.6 %) (Fig. 1), i.e., the FFR value was under 0.80 despite having being obtained immediately after PCI that was judged successful based on findings from CAG and IVUS.…”

Section: Discussioncontrasting

confidence: 67%

“…However, vessel diameter as estimated based on implanted stents seemed to be insufficient to perfuse the broad territory of the LAD. The FFR value obtained immediately after BMS implantation predicts TVR [6], which is a truth also for DESs [8]. Patients, whose target vessel's FFR cannot be improved sufficiently, may have a diffuse sclerotic change in the vessel and will have a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…In the DES era, longer stents are increasingly implanted to obtain better FFR after PCI. The higher intracoronary residual pressure gradient was associated with the higher incidences of adverse cardiac events [death, TVR, target lesion revascularization (TLR), MI, and PCI for non-target vessel] even after DES implantation [7,8]. Additional reports to reveal the FFR cutoff value after DES implantation for prognosis prediction are expected, whereas the FFR value below 0.80 before PCI was considered as significant inducible myocardial ischemia [3-5, 9, 10].…”

Section: Introductionmentioning

confidence: 98%

“…PCI for vessels, whose FFR value is 0.75 or greater, has been reported to have no advantage over deferral strategy [2], FFR guidance in patients undergoing PCI with drugeluting stents (DESs) significantly reduced mortality and the incidence of myocardial infarction (MI) [3,4], and PCI with DESs for the vessels with an FFR of B0.80 decreased the incidence of adverse cardiac events [5]. Furthermore, residual pressure gradient, which indicates the presence of a residual lesion even after the implantation of bare-metal stents (BMSs) or DESs, was shown to be a predictor of target vessel revascularization (TVR) [6][7][8]. Pijls et al reported that patients presenting an FFR of C0.90 immediately after BMS implantation had a better disease prognosis as compared with patients whose target vessel's FFR value is below 0.90 [6].…”

Section: Introductionmentioning

confidence: 99%

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Characterization of real-world patients with low fractional flow reserve immediately after drug-eluting stents implantation

Kimura

Tanaka

Okura

et al. 2015

Cardiovasc Interv and Ther

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Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for coronary artery disease has been validated. The present study aimed to identify the variables that influence FFR immediately after drug-eluting stents (DESs) implantation. We retrospectively analyzed 167 patients, who had been implanted with DESs at 6 Japanese institutions and had obtained the FFR values before and immediately after PCI. Intravascular ultrasound (IVUS) was used to build a PCI strategy and to decide the completion of the PCI procedure in all case. Patients were categorized into the following 2 groups according to FFR after PCI: the low FFR (≤0.80) group and the high FFR (>0.80) group. Despite successful PCI evaluated by coronary angiography and IVUS, 18.6 % of real-world patients were in the low FFR group. The proportion of the left anterior descending artery (LAD) was significantly greater in the low FFR group than in the high FFR group (87.1 vs 56.6 %; P < 0.01). Multivariate logistic regression analysis revealed that the LAD-to-non-LAD odds ratio for a low FFR (≤0.80) was 7.34 (95 % CI 1.63-32.95; P < 0.01) after adjustment for FFR value before PCI, suggesting that it is difficult to improve the hemodynamics of the LAD lesions even after successful PCI. The LAD was the strongest contributor to the inadequate recovery of FFR immediately after PCI, thus eliciting heed when treating the LAD lesions.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Characterization of real-world patients with low fractional flow reserve immediately after drug-eluting stents implantation

Kimura

Tanaka

Okura

et al. 2015

Cardiovasc Interv and Ther

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“…Consequently, the number of patients included in the present analysis is twice as large as most of the previously published studies from the DES era together. [23][24][25][26][27] The end point-VOCE-was used to match as closely as possible post-PCI vessel characteristics and patients clinical outcome. Moreover, all end points were adjudicated by an independent clinical event committee blinded to all clinical data including post-PCI FFR values.…”

Section: Previous Data With Post-pci Ffrmentioning

confidence: 99%

Prognostic Value of Fractional Flow Reserve Measured Immediately After Drug-Eluting Stent Implantation

Piróth

Tóth

Tonino

et al. 2017

Circ: Cardiovascular Interventions

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104

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Background— The predictive value of fractional flow reserve (FFR) measured immediately after percutaneous coronary intervention (PCI) with drug-eluting stent placement has not been prospectively investigated. We investigated the potential of post-PCI FFR measurements to predict clinical outcome in patients from FAME 1 and 2 trials (Fractional Flow Reserve or Angiography for Multivessel Evaluation). Methods and Results— All patients of FAME 1 and FAME 2 who had post-PCI FFR measurement were included. The primary outcome was vessel-oriented composite end point at 2 years, defined as vessel-related cardiovascular death, vessel-related spontaneous myocardial infarction, and ischemia-driven target vessel revascularization. Eight hundred thirty-eight vessels in 639 patients were analyzed. Baseline FFR values did not differ between vessels with versus without vessel-oriented composite end point (0.66±0.11 versus 0.63±0.14, respectively; P =0.207). Post-PCI FFR was significantly lower in vessels with vessel-oriented composite end point (0.88±0.06 versus 0.90±0.06, respectively; P =0.019). Comparing the 2-year outcome of lower and upper tertiles of post-PCI FFR significant difference was found favoring upper tertile in terms of overall vessel-oriented composite end point (9.2% versus 3.8%, respectively; hazard ratio, 1.46; 95% confidence interval, 1.02–2.08; P =0.037) and target vessel revascularization (7.0% versus 2.4%, respectively; hazard ratio, 1.59; 95% confidence interval, 1.03–2.46; P =0.037). When adjusted to sex, hypertension, diabetes mellitus, target vessel, serial stenosis, and baseline percentage diameter stenosis, a strong trend was preserved in terms of target vessel revascularization (harzard ratio, 1.55; 95% confidence interval, 0.97–2.46; P =0.066), favoring the upper tertile. Post-PCI FFR of 0.92 was found to have the highest diagnostic accuracy; however, the positive likelihood ratio remained low (<1.4). Conclusions— A higher post-PCI FFR value is associated with a better vessel-related outcome. However, its predictive value is too low to advocate its use as a surrogate clinical end point.

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Prognostic Implications of Fractional Flow Reserve After Coronary Stenting

et al. 2022

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ImportanceFractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is generally considered to reflect residual disease. Yet the clinical relevance of post-PCI FFR after drug-eluting stent (DES) implantation remains unclear.ObjectiveTo evaluate the clinical relevance of post-PCI FFR measurement after DES implantation.Data SourcesMEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant published articles from inception to June 18, 2022.Study SelectionPublished articles that reported post-PCI FFR after DES implantation and its association with clinical outcomes were included.Data Extraction and SynthesisPatient-level data were collected from the corresponding authors of 17 cohorts using a standardized spreadsheet. Meta-estimates for primary and secondary outcomes were analyzed per patient and using mixed-effects Cox proportional hazard regression with registry identifiers included as a random effect. All processes followed the Preferred Reporting Items for Systematic Review and Meta-analysis of Individual Participant Data.Main Outcomes and MeasuresThe primary outcome was target vessel failure (TVF) at 2 years, a composite of cardiac death, target vessel myocardial infarction (TVMI), and target vessel revascularization (TVR). The secondary outcome was a composite of cardiac death or TVMI at 2 years.ResultsOf 2268 articles identified, 29 studies met selection criteria. Of these, 28 articles from 17 cohorts provided data, including a total of 5277 patients with 5869 vessels who underwent FFR measurement after DES implantation. Mean (SD) age was 64.4 (10.1) years and 4141 patients (78.5%) were men. Median (IQR) post-PCI FFR was 0.89 (0.84-0.94) and 690 vessels (11.8%) had a post-PCI FFR of 0.80 or below. The cumulative incidence of TVF was 340 patients (7.2%), with cardiac death or TVMI occurring in 111 patients (2.4%) at 2 years. Lower post-PCI FFR significantly increased the risk of TVF (adjusted hazard ratio [HR] per 0.01 FFR decrease, 1.04; 95% CI, 1.02-1.05; P < .001). The risk of cardiac death or MI also increased inversely with post-PCI FFR (adjusted HR, 1.03; 95% CI, 1.00-1.07, P = .049). These associations were consistent regardless of age, sex, the presence of hypertension or diabetes, and clinical diagnosis.Conclusions and RelevanceReduced FFR after DES implantation was common and associated with the risks of TVF and of cardiac death or TVMI. These results indicate the prognostic value of post-PCI physiologic assessment after DES implantation.

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

Cited by 80 publications

References 17 publications

Characterization of real-world patients with low fractional flow reserve immediately after drug-eluting stents implantation

Characterization of real-world patients with low fractional flow reserve immediately after drug-eluting stents implantation

Prognostic Value of Fractional Flow Reserve Measured Immediately After Drug-Eluting Stent Implantation

Prognostic Implications of Fractional Flow Reserve After Coronary Stenting

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