TCT 2020 | New Information about Pre and Post PCI FFR Value

The TARGET FFR and DEFINE-FLOW studies were presented at TCT 2020 which have offer a deeper perspective on the value of FFR, not only before but also after PCI.

TARGET FFR

The TARGET FFR included 260 patients randomized after angiographically successful PCI to an FFR guided optimization vs. blinded FFR assessment strategies. 

In the guided group the FFR pullback of stented vessels found targets for further optimization in 46% of patients which led to additional post dilation or stenting of other vessel segments in 66% of cases, resulting in increased mean post-PCI FFR from 0.76 to 0.82, with a larger increase seen with stenting rather than with post dilation. 

This optimization prolonged the procedure, and increased radiation exposure, contrast volume and adenosine dose, even though this did not seem to translate into clinical adverse events.

Achieving final post-PCI FFR ≥0.90 was numerically more frequent in the optimization arm (38.1% vs 28.1%; p=0.099). The number of patients with final FFR value <0.8 did result significantly lower (18.6% vs 29.8%; p=0.045). 


Read also: TCT 2020 | Xience in Favor of Short Dual Antiaggregation Therapy with High Bleeding Risk.


As in previous registries, FFR value resulted lower when the artery to treat was the anterior descending vs. the left circumflex or the right coronary arteries. 

It is distressing the number of patients in the angiography guided arm assessed by blinded FFR who completed the procedure with suboptimal values. 

DEFINE-FLOW

In the past few years there has been a growing interest in better understanding microvascular abnormalities, and the second study presented (DEFINE-FLOW) is one of the first to examine this point. 

The hypothesis behind this study was that treated patients who had FFR < 0.8 but intact CRF (>2) would have results comparable to those with normal FFR and CFR values. 

The DEFINE-FLOW included 430 patients with 533 stable lesions that underwent simultaneous FFR and CFR assessment. Only lesions with low FFR and CFR underwent PCI. All other combinations, including FFR <0.8 but conserved CFR were deferred and treated medically. 


Read also: TCT 2020 | Acurate Neo Does Not Meet Non-Inferiority vs. CoreValve Evolut.


 At 2 years, the primary endpoint of all-cause death, MI, and revascularization rates differed across the four possible combinations. The best prognosis was for patients with negative FFR and CFR and the highest rate of events was on the opposite side, patients with positive FFR and CFR (<0.8 and <0.2, respectively) who underwent PCI.

Lesions with FFR <0.8 and normal CFR showed a 5% higher events rate vs. patients with normal values. 

In other words, FFR value does matter, even with normal CFR.

Original Title: TARGET FFR: A randomized trial of physiology-guided PCI optimization y DEFINE-FLOW: an observational study of deferred lesions after FFR and CFR assessment.

Reference: El estudio TARGET FFR fue presentado por el Dr Collison D y el estudio DEFINE-FLOW por el Dr Johnson N. Ambos trabajos fueron presentados en el TCT 2020 virtual.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....