Relation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes

doi:10.1016/j.amjcard.2011.02.329

The American Journal of Cardiology

Volume 107, Issue 12, 15 June 2011, Pages 1763-1767

https://doi.org/10.1016/j.amjcard.2011.02.329 Get rights and content

Patients still present with drug-eluting stent (DES) failure despite an angiographically successful implantation. The aim of the present study was to investigate the relation between the fractional flow reserve (FFR) measured after DES implantation and the clinical outcomes at 1 year. A total of 80 patients (mean age 62 years, 74% men, 99 DESs) underwent coronary pressure measurement at maximum hyperemia after successful DES implantation. The composite of major adverse cardiac events (MACE), including death, myocardial infarction, and ischemia-driven target vessel revascularization was evaluated at 1 year. The patients were divided into 2 groups (low-FFR group, FFR ≤0.90 and high-FFR group, FFR >0.90) according to the median FFR. The mean poststent percent diameter stenosis was 11 ± 5% in the low-FFR group and 12 ± 3% in the high-FFR group (p = 0.31). Left anterior descending coronary artery lesions were more frequent in the low-FFR group than in the high-FFR group (82% vs 55%, p = 0.02). The mean stent length was greater in the low-FFR group than in the high-FFR group (38 ± 18 vs 28 ± 13 mm, p = 0.01). Six cases (7.5%) of MACE occurred during the 1-year follow-up. The rate of MACE was 12.5% in the low-FFR group and 2.5% in the high-FFR group (p <0.01). Receiver operating characteristic curves revealed 0.90 as the best cutoff of FFR after DES implantation for the prediction of 1-year MACE. In conclusion, a poststent FFR of ≤0.90 correlated with a greater adverse event rate at 1 year.

Section snippets

Methods

The study population consisted of 80 patients who underwent FFR measurement immediately after angiographically successful PCI with DES implantation in de novo coronary lesions. The angiographic success of PCI was defined as residual stenosis <20% by visual assessment with Thrombolysis In Myocardial Infarction grade 3 coronary flow and FFR ≥0.80. The patients were not eligible for enrollment if they had undergone intervention in the setting of primary or emergent PCI for acute coronary syndrome,

Results

The baseline clinical characteristics, angiographic characteristics, and quantitative coronary angiographic results are summarized in Table 1, Table 2. The average number of DESs deployed per target lesion was 1.2 ± 0.4. Three types of DESs were implanted (sirolimus-eluting stent, 51%; paclitaxel-eluting stent, 39%; and zotarolimus-eluting stent, 10%). No complications attributable to FFR measurement occurred in any of the studied patients. The patients were divided into 2 groups according to

Discussion

The results of the present study have revealed, first, that the 1-year clinical outcome after DES implantation correlated with the poststent FFR; and second, that an FFR cutoff of 0.90 might be a useful indicator in daily practice for optimal physiologic DES implantation.

Although DES use has significantly reduced the rate of restenosis after PCI, 5% to 10% of stented patients develop MACE within 12 months after optimal angiographic stent implantation.² This might be due to angiographically

Acknowledgment

The authors thank Dr. Roberto Patarca for editorial help.

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Fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is associated with long-term outcomes. Data relating FFR-based trans-stent gradient (TSG) after PCI to long-term outcomes are sparse.
The aim of this study was to test whether TSG is associated with adverse events at follow-up after PCI.
Data were gathered from a prospective registry evaluating 501 vessels in 416 patients with median follow-up period of 596 days. Primary endpoints were: 1) target vessel failure (TVF), including target vessel revascularization, and target vessel myocardial infarction after discharge; and 2) major adverse cardiac events (MACE) including TVF, target vessel revascularization, nontarget vessel MI, cardiac death.
After PCI, median post-PCI FFR was 0.86 and median TSG was 0.04. TSG >0.04 was associated with increased rates of TVF (8.7% vs 2.9%; P = 0.014) and MACE (17.8% vs 9.2%; P = 0.02). Post-PCI FFR < 0.86 was associated with increased rates of TVF (6.1% vs 2.2%; P = 0.03) and MACE (16.5% vs 10%; P = 0.036). The vessel subgroup with high TSG and low FFR had significantly higher rates of TVF (10.2%; P = 0.02) and MACE (20.1%; P = 0.049) than vessels with: 1) high TSG and high FFR (TVF, 2.9%; MACE, 9.7%); 2) low TSG and low FFR (TVF, 3.8%; MACE, 11.3%); and 3) low TSG high FFR (TVF, 2.2%; MACE, 7.5%). In multivariate analysis, TSG was independently predictive of TVF.
Higher TSG was an independent predictor of adverse events, particularly TVF, and identified a subgroup of patients at higher risk for poor outcomes. The combination of high TSG and low FFR showed significantly worse outcomes compared with an “ideal result” (high FFR and low TSG). These data support a recommendation to use TSG during FFR evaluation to determine the functional success of PCI.

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: Y.-N. Kim received research grant RTI04-01-01 from the Regional Technology Innovation Program of the Ministry of Knowledge Economy (MKE), Seoul, Korea.

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Coronary artery diseaseRelation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes

Section snippets

Methods

Results

Discussion

Acknowledgment

J Am Coll Cardiol

JACC Cardiovasc Interv

Our preoccupation with coronary luminology: the dissociation between clinical and angiographic findings in ischemic heart disease

Circulation

Comparison of an everolimus-eluting stent and a paclitaxel-eluting stent in patients with coronary artery disease: a randomized trial

JAMA

Final results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) study

Circulation

Fractional flow reserve compared with intravascular ultrasound guidance for optimizing stent deployment

Circulation

Comparison of quantitative coronary angiography, intravascular ultrasound, and coronary pressure measurement to assess optimum stent deployment

Circulation

Prediction of the physiologic severity of coronary lesions using 3D IVUS: validation by direct coronary pressure measurements

Catheter Cardiovasc Interv

Coronary artery disease
Relation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes