Impact of Post-PCI FFR Stratified by Coronary Artery

Authors

• Carlos Collet
• Nils P Johnson
• Takuya Mizukami
• William F Fearon
• Colin Berry
• Jeroen Sonck
• Damien Collison
• Bon-Kwon Koo
• Nicolas Meneveau
• Shiv Kumar Agarwal
• Barry Uretsky
• Abdul Hakeem
• Joon-Hyung Doh
• Bruno R Da Costa
• Keith G Oldroyd
• Jonathon A Leipsic
• Umberto Morbiducci
• Charles Taylor
• Brian Ko
• Pim A L Tonino
• Divaka Perera
• Toshiro Shinke
• Claudio Chiastra
• Andrei C Sposito
• Antonio Maria Leone
• Olivier Muller
• Stephane Fournier
• Hitoshi Matsuo
• Julien Adjedj
• Nicolas Amabile
• Zsolt Piróth
• Fernando Alfonso
• Fernando Rivero
• Jung-Min Ahn
• Gabor G Toth
• Abdul Ihdayhid
• Nick E J West
• Tetsuya Amano
• Eric Wyffels
• Daniel Munhoz
• Marta Belmonte
• Hirofumi Ohashi
• Koshiro Sakai
• Emanuele Gallinoro
• Emanuele Barbato
• Thomas Engstrøm
• Javier Escaned
• Ziad A Ali
• Morton J Kern
• Nico H J Pijls
• Peter Jüni
• Bernard De Bruyne

Language

English

Publication Date

10-9-2023

Journal

JACC: Cardiovascular Interventions

DOI

10.1016/j.jcin.2023.08.018

PMID

37821185

Abstract

Background: Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated.

Objectives: This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery.

Methods: We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization.

Results: Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005).

Conclusions: The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.

Keywords

Humans, Coronary Artery Disease, Percutaneous Coronary Intervention, Fractional Flow Reserve, Myocardial, Coronary Angiography, Treatment Outcome, Predictive Value of Tests, coronary artery disease, diffuse disease, percutaneous coronary intervention, post-PCI fractional flow reserve

Published Open-Access

yes

Recommended Citation

Collet, Carlos; Johnson, Nils P; Mizukami, Takuya; et al., "Impact of Post-PCI FFR Stratified by Coronary Artery" (2023). Faculty, Staff and Student Publications. 3616.
https://digitalcommons.library.tmc.edu/uthmed_docs/3616