Post PCI FFR Reduces MACE

Original Title: Utilizing Post-Intervention Fractional Flow Reserve to Optimize Acute Results and the Relationship to Long-Term Outcomes

Reference: Shiv K. Agarwal, et al. JACC Cardiovascular Intervention 2016;9:1022-31

 

Courtesy of Dr. Carlos Fava.

 

FFR post PCIFractional flow reserve has shown benefits and it is considered the gold standard to assess intermediate lesions (Class IA), but its use post PCI has not been evaluated yet.

574 patients with 664 lesions were analyzed; 45% had a history of diabetes, 48% multivessel disease and 45% diffuse disease.

Previous obstruction degree by quantitative angiography was 73±15%, 96% with FFR ≤0.80 and 73% FFR ≤0.75, regardless adenosine administration technique.

After PCI with angiographically satisfactory results, 21% (143 lesions) presented a suboptimal FFR ≤0.80 (0.75±0.05). After a second intervention to this group (post balloon dilation, subsequent stent implantation, or IVUS or OCT lesion assessment) FFR increased to 0.87±0.06 (p<0.0001). 9% continued with suboptimal FFR.

This was associated to longer procedural and fluoroscopy time, but not with more contrast.

Follow up was at 31 months with 19% of patients presenting some event (62 death by any cause, 12 MI, and 60 revascularizations).

MACE predictors were ACS, diffuse lesions and ≤0.86 final FFR.

In ROC curve analyzis, final FFR cutoff value predictor of MACE was ≤0.86 (23% vs. 17% p=0.02), for death ≤0.87 (13.5% vs. 9% p=0.03) and TVR ≤0.85 (12% vs. 8% p=0.03).

Conclusion

Post PCI FFR reclassifies 20% of PCI with satisfactory results, requiring more intervention to achieve complete functional revascularization at the time of index procedure. Post PCI FFR is an independent predictor of long term evolution.

Editorial Comment

This analyzis shows the concept of PCI “Functional Optimization”, because 20% of patients present ischemia after a satisfactory angiography.

Ideally, we should identify the groups that could benefit from this strategy in order not to unnecessarily prolong procedures and to save costs.

Courtesy of Dr. Carlos Fava. Favaloro Foundation, Buenos Aires, Argentina.

We value your opinion. You are more than welcome to leave your comments, thoughts, questions or any ideas here below.

More articles by this author

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...

iFR- vs. FFR-Guided Coronary Revascularization: 5-Year Clinical Outcomes

The assessment of coronary stenosis using coronary physiology has become a key tool in guiding revascularization. The two most widely used techniques are fractional...

Patients at High Risk of Bleeding After Coronary Angioplasty: Are Risk Assessment Tools ARC-HBR and PRECISE-DAPT Useful?

Patients undergoing coronary stenting typically receive dual antiplatelet therapy (DAPT) for 6 to 12 months, consisting of a P2Y12 receptor inhibitor and aspirin. While DAPT...

ACC 2025 | WARRIOR: Ischemia in Women with Non-Obstructive Coronary Artery Disease

Approximately half of all women with symptomatic ischemia who undergo coronary angiography are found to have non-obstructive coronary artery disease ((ischemia and non-obstructive coronary...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Percutaneous Tricuspid Valve Replacement with Lux-Valve

Tricuspid regurgitation (TR) is a condition associated with poor quality of life, frequent hospitalizations due to heart failure, and increased mortality, even under optimal...

Transcatheter Pulmonary Valve Implantation with a Self-Expanding Valve: Outcomes at 3 Years

Pulmonary regurgitation (PR) is a common condition in patients who have undergone surgical repair of Tetralogy of Fallot or other pathologies involving the right...

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...