Suboptimal fractional flow reserve (FFR) results after stenting only have a moderate impact on clinical hard points but might predict a much higher risk of reintervention.
FFR has shown a huge impact on the decision-making process when it comes to revascularizing (or not) a lesion. Its impact after angioplasty has not been fully studied, particularly in the long term. We know the thresholds before angioplasty, but should there be target values after that procedure? If FFR does not improve as much as we expected after stenting, should it be optimized, somehow?
This large-scale study included all patients who underwent FFR-guided angioplasty.
FFR was measured immediately after angioplasty and then once the operator considered the outcome as acceptable and final. These results were only observational, since no action was taken based on them.
A suboptimal result was defined as final FFR <0.90. The final endpoint was a composite of cardiac death, infarction, and any revascularization after a 2-year follow-up.
With 1000 patients included and 1165 vessels analyzed, FFR after angioplasty was <0.9 in 440 vessels (37.8%). Almost 400 patients left the cath lab with at least one vessel whose FFR was suboptimal. This accounts for over a third of the procedures; its frequency is surprising. We should remember that no action was taken based on these results.
The analysis per patient did not show a significant association between FFR results after angioplasty and combined events after 2 years of follow-up (hazard ratio [HR]: 1.08, 95% confidence interval [CI]: 0.73 to 1.60; p = 0.707). Upon consideration of each event separately, no association was found either.
The analysis per vessel offered different results. FFR <0.9 after angioplasty was associated with almost twice as many target-vessel revascularizations (HR: 1.91; 95% CI: 1.06 to 3.44; p = 0.030) and a higher risk for thrombosis.
Suboptimal FFR after angioplasty had no significant impact on hard cardiovascular events, but it was associated with almost twice as many target-vessel revascularizations.
Original Title: Impact of Poststenting Fractional Flow Reserve on Long-Term Clinical Outcomes. The FFR-SEARCH Study.
Reference: Roberto Diletti et al. Circ Cardiovasc Interv. 2021;14:e009681. DOI: 10.1161/CIRCINTERVENTIONS.120.009681.