Post-PCI FFR independently predicted target vessel failure and death/MI with an optimal cutoff of 0.83, while post-PCI QFR overestimated FFR and lacked prognostic value.
Does post-PCI FFR or QFR predict long-term target vessel failure in patients undergoing PCI with DES?
Post-PCI FFR, but not QFR, is an independent predictor of long-term target vessel failure and hard clinical endpoints after DES implantation.
Absolute Event Rate: 0% vs 0%
Abstract Background The role of functional assessment after angiographically acceptable post-PCI result is debatable. Aim The aim of the present study was to evaluate the correlation between post-PCI fractional flow reserve (FFR) and quantitative flow ratio (QFR), clarify their relationship with clinical parameters, and compare their relative prognostic value in predicting long-term outcome. Methods Coronary arteries that underwent post-PCI (DES) FFR measurement at our tertiary care centre between March 2010 and January 2021 were consecutively included in this registry. Post-PCI QFR was calculated off-line, blinded to the value of post-PCI FFR and the clinical outcome. We analysed the influence of the following variables on post-PCI FFR and QFR: gender, age, hypertension, diabetes mellitus, hyperlipidaemia, estimated glomerular filtration rate, indication (acute vs. chronic coronary syndrome), left anterior descending (LAD) vs. non-LAD location, stent diameter, in-stent restenosis (ISR) vs. de novo lesion category, proximal vs. non-proximal lesions, severe aortic stenosis, atrial fibrillation (AF) during the procedure, and prior myocardial infarction in the supply area. The primary endpoint was target vessel failure (TVF) defined as the composite of cardiovascular death (CD), target vessel-related non-fatal myocardial infarction (MI), and target vessel repeat revascularization (TVR). The secondary endpoint was the composite of CD and MI. Median follow-up was 50 months. Optimal cut-off was determined by ROC curves. Results QFR calculation was unsuccessful in 15.6% of the vessels, thus 422 vessels of 365 patients were included in the analysis. Post-PCI QFR systematically overestimated post-PCI FFR with a mean bias of +0.05, and their correlation was poor (Pearson’s r=0.424). Lower post-PCI FFR was associated with LAD location (p0.001), male gender (p=0.001), smaller stent diameter (p=0.007), and impaired eGFR (p=0.03). Lower post-PCI QFR correlated with LAD location (p=0.001), shorter stent length (p0.001), AF during the procedure (p=0.001), ISR (p=0.006), and non-proximal lesion location (p=0.001). During follow-up, 23 CDs, 14 MIs, and 39 TVRs occurred. Post-PCI FFR independently predicted TVF (p0.001) and CD/MI (p0.001), with an optimal cut-off of 0.83 for predicting TVF in the total patient population, 0.83 for LAD lesions, and 0.89 for non-LAD lesions. Post-PCI QFR was associated with TVF in univariate analysis (p=0.013), but was not an independent predictor of TVF or CD/MI, and no optimal QFR cut-off was identified. Conclusions Post-PCI FFR is an independent predictor of TVF and CD/MI, while post-PCI QFR systematically overestimates post-PCI FFR and lacks prognostic independence. The optimal cut-off of post-PCI FFR to predict TVF was 0.83, whereas no optimal cut-off of post-PCI QFR could be found.
Csanádi et al. (Sat,) reported a other. Post-PCI FFR independently predicted target vessel failure and death/MI with an optimal cutoff of 0.83, while post-PCI QFR overestimated FFR and lacked prognostic value.
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