An FFR-guided optimization strategy did not significantly increase the proportion of patients with final FFR ≥0.90 but reduced final FFR ≤0.80 by 11.2%.
Does a physiology-guided incremental optimization strategy improve the proportion of patients achieving a final post-PCI FFR ≥0.90 compared to standard coronary angiography in patients undergoing PCI?
An FFR-guided optimization strategy post-PCI did not significantly increase the proportion of patients achieving an optimal FFR ≥0.90, but it successfully reduced the proportion of patients left with a severely suboptimal FFR ≤0.80.
Absolute Event Rate: 0% vs 0%
Abstract Aims A fractional flow reserve (FFR) value ≥0.90 after percutaneous coronary intervention (PCI) is associated with a reduced risk of adverse cardiovascular events. TARGET-FFR is an investigator-initiated, single-centre, randomized controlled trial to determine the feasibility and efficacy of a post-PCI FFR-guided optimization strategy vs. standard coronary angiography in achieving final post-PCI FFR values ≥0.90. Methods and results After angiographically guided PCI, patients were randomized 1:1 to receive a physiology-guided incremental optimization strategy (PIOS) or a blinded coronary physiology assessment (control group). The primary outcome was the proportion of patients with a final post-PCI FFR ≥0.90. Final FFR ≤0.80 was a prioritized secondary outcome. A total of 260 patients were randomized (131 to PIOS, 129 to control) and 68.1% of patients had an initial post-PCI FFR 0.90. In the PIOS group, 30.5% underwent further intervention (stent post-dilation and/or additional stenting). There was no significant difference in the primary endpoint of the proportion of patients with final post-PCI FFR ≥0.90 between groups (PIOS minus control 10%, 95% confidence interval −1.84 to 21.91, P = 0.099). The proportion of patients with a final FFR ≤0.80 was significantly reduced when compared with the angiography-guided control group (−11.2%, 95% confidence interval −21.87 to −0.35], P = 0.045). Conclusion Over two-thirds of patients had a physiologically suboptimal result after angiography-guided PCI. An FFR-guided optimization strategy did not significantly increase the proportion of patients with a final FFR ≥0.90, but did reduce the proportion of patients with a final FFR ≤0.80.
Collison et al. (Tue,) reported a other. An FFR-guided optimization strategy did not significantly increase the proportion of patients with final FFR ≥0.90 but reduced final FFR ≤0.80 by 11.2%.