Patients undergoing acute coronary syndrome (ACS) benefit from percutaneous coronary intervention (PCI). At present, there is no question about this. However, residual ischemia after PCI is associated with a worse prognosis. Angiography studies and intravascular imaging are useful to assess post intervention outcomes, but they are limited when it comes to the physiological assessment of lesions.
Recent reports have shown that optical coherence tomography-derived fractional flow reserve (OCT-FFR) correlates strongly with conventional wire-based FFR.
The aim of this retrospective, multicenter, observational study was to look into the long-term correlation of post PCI OCT-FFR and clinical outcomes in ACS patients.
Primary end point was target vessel failure (TVF), a composite of cardiovascular death, target vessel MI and ischemia driven target vessel revascularization.
364 patients were included, mean age 69, and mostly men. The most frequent clinical presentation was non-ST elevation MI, and the most affected artery was the anterior descending.
During a 36-month follow-up, TVF occurred in 14% of patients. OCT-FFR was significantly lower in the TVF group when compared against the non-TVF group (p<0.001). The incidence of TVF was 9 times higher in vessels with low OCT-FFR values (<0.90) vs. vessels with high OCT-FFR values (>0.90).
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Moreover, the incidence of cardiovascular death and target vessel revascularization was significantly higher in patients with low OCT-FFR. Patients in the TVF group has smaller average lumen area (p<0.001) and smaller minimal lumen area (p<0.001) than those in the non TVF group.
Factors associated to low OCT-FFR levels were lesions to the anterior descending artery, small instent minimal lumen area, instent thrombosis, proximal stent edge dissection, long non-culprit lesion and with minimal lumen area.
Conclusion
This study revealed that post PCI OCT-FFR is independent from TVF. Measuring OCT-FFR and considering an additional strategy in PCI might improve clinical outcomes in ACS patients.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: Optical Coherence Tomography Fractional Flow Reserve and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome.
Reference: Shunsuke Kakizaki, MD et alJ Am Coll Cardiol Intv 2022.
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