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.
Fractional 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.
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