Percutaneous coronary revascularization of a stenosis did not meaningfully change the fractional flow reserve of parallel non-PCI lesions (median change 0.01, IQR -0.01 to 0.03).
Observational (n=144)
Yes
Does percutaneous coronary revascularization of a lesion impact the fractional flow reserve (FFR) and non-hyperemic pressure ratios (NHPR) of parallel stenoses in patients with multivessel disease?
Revascularization of a coronary stenosis does not significantly alter the hemodynamic relevance (FFR or NHPR) of parallel stenoses in other coronary territories, suggesting their hemodynamic influence on each other is negligible.
Effect estimate: Median change 0.01
Absolute Event Rate: 0.84% vs 0.84%
Abstract Background It is conceivable that lesions located parallel, e.g., lesions in the left anterior descending artery (LAD) and left circumflex artery (LCX), influence each other's hemodynamics. However, data on the impact of a revascularization of a coronary artery stenosis on the hemodynamic relevance of stenoses in other coronary territories is limited. Therefore, we analyzed the impact of percutaneous coronary revascularization (PCI) on fractional flow reserve (FFR) measurements in stenoses located in other coronary territories. Methods This multicenter study prospectively included patients with multivessel disease, coronary artery stenoses in at least two parallel coronary artery branches and planned percutaneous revascularization of at least one lesion (PCI lesion). Both FFR and non-hyperemic pressure ratios (NHPR) were measured in the non-PCI lesion before and after treatment of the PCI lesion. Results Overall, 144 patients were included. The median age was 70.5 years (IQR: 61.0 – 77.0 years) and 29 patients (20.1%) were female. The non-PCI lesion was located in the LAD or one of its branches in 72 cases (47.1%) and in the LCX or one of its branches in 81 cases (52.9%), whereas the PCI lesion was located in the LAD or one of its branches in 87 cases (56.9%) and in the LCX or one of its branches in 66 cases (43.1%). Median FFR of the non-PCI lesion was 0.84 (IQR: 0.77 – 0.90) before and 0.84 (IQR: 0.76 – 0.89) after PCI of the PCI lesion. Hence, FFR in the parallel lesion changed by a median of 0.01 (IQR: -0.01 – 0.03, Figure). NHPR changed by a median of 0.00 (IQR: -0.01 – 0.03, Figure). In 12.4% of the lesions FFR changed in such a way that the threshold value of ≤0.80 for the hemodynamic relevance was crossed and in 14.4% (n=21) of the lesions the NHPR crossed the threshold of ≤0.89 for the hemodynamic relevance (Figure), resulting in a different assessment of the parallel lesion before and after the PCI in these cases. The location of the PCI or non-PCI lesion did not significantly influence the effect of the revascularization on the difference between pre- and post-PCI FFR (p=0.426) and NHPR (p=0.265) measurements. Conclusions Neither FFR nor NHPR of coronary artery lesions are influenced by revascularization of coronary artery stenoses in parallel vessels. This suggests the influence of parallel stenoses on each other’s hemodynamics is negligible.
Altstidl et al. (Sat,) conducted a observational in Multivessel coronary artery disease (n=144). Percutaneous coronary revascularization (PCI) vs. Pre-PCI baseline (within-patient comparison) was evaluated on Fractional flow reserve (FFR) in the non-PCI lesion (Median change 0.01). Percutaneous coronary revascularization of a stenosis did not meaningfully change the fractional flow reserve of parallel non-PCI lesions (median change 0.01, IQR -0.01 to 0.03).