Stenting a coronary lesion should not present a drop in pressure when measuring the treated segment with fractional flow reserve (FFR). FFR based trans-stent gradient should involve a segment of the sub-expanded vessel or instent obstruction as plaque prolapse or thrombus.
The link between post-stenting physiology and long-term outcomes have been looked at in several studies, and it has been shown that a proportion of patients with post-intervention suboptimal physiology owes this to focal lesions or segments related to the stent that can be modified to improve flow and therefore long-term results.
The aim of this prospective study was to assess whether trans-stent gradient is associated to adverse events at 2-year followup after PCI.
Primary end point was target vessel failure (TVF) defined as target vessel revascularization, target vessel MI and a combination of major cardiovascular events (MACE; cardiovascular death, MI, target vessel revascularization).
It included 417 patients, mean age 65. Most were men. Mean FFR pre-PCI was 0.69, and post FFR was 0.85, with a significant increase (P< 0.0001). Patients were divided into 4 groups: Group I (FFR ≤ 0.86 and TSG >0.04), Group II (FFR ≤0.86 and TSG < 0.04), Group III (FFR > 0.86 and TSG > 0.04) and Group IV (FFR >0.86 and TSG ≤ 0.04).
When looking at TSG (>0.04) there was an increase in TVF (P=0.014) and MACE (P=0.02). When looking at FFR, ≤0.86 was associated to increased TVF (P=0.03) and MACE (P=0.036) rates. Group I (high TSG and low FFR) had significantly higher rates of TVF and MACE (10.2% and 20.1%, respectively, P=0.049) compared to the rest of groups.
At multivariable analysis, TSG was an independent predictor of TVF.
Post PCI TSG is an independent predictor of adverse events, and it helps identify a subgroup of patients at high risk of adverse events at followup. Patients with high TSG and low FFR showed worse prognosis at long term. These outcomes help optimize PCI results after stent implantation.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Reference: Barry F. Uretsky, MD et al J Am Coll Cardiol Intv 2022;15:2192–2202.
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