Why the study?
The authors sought to investigate how the target vessel influences the prognostic relevance of fractional flow reserve measured after percutaneous coronary intervention.
Does the prognostic relevance and optimal cut-off value of post-PCI FFR differ between LAD and non-LAD target vessels?
Does the prognostic relevance and optimal cut-off value of post-PCI FFR differ between LAD and non-LAD target vessels?
Higher post-PCI FFR is associated with better clinical outcomes, but the optimal prognostic cut-off values differ significantly depending on whether the target vessel is the LAD (0.82) or non-LAD (0.88).
Vessel-specific post-PCI FFR thresholds may refine TVF risk stratification; hypothesis-generating and requires randomized validation before adoption.
AIMS: We sought to investigate the influence of the target vessel on the prognostic relevance of fractional flow reserve (FFR) after percutaneous coronary intervention (PCI). METHODS AND RESULTS: A total of 835 patients with available FFR after second-generation drug-eluting stent (DES) implantation were included in this study. The primary outcome was target-vessel failure (TVF), including cardiac death, target vessel-related myocardial infarction, and clinically driven target vessel revascularisation. The target vessel was the left anterior descending artery (LAD) in 603 patients (72.2%) and non-LAD in 232 patients (27.8%). The distribution pattern of post-PCI FFR values was different between the LAD and non-LAD (p<0.001). The optimal cut-off values of post-PCI FFR for predicting TVF were 0.82 and 0.88 in the LAD and non-LAD, respectively. The cumulative incidence of TVF was significantly higher in patients with lower post-PCI FFR than each cut-off value (10.9% vs. 2.5%, hazard ratio [HR] 4.08, 95% confidence interval [CI]: 2.63-6.34, p<0.001 in LAD; 8.0% vs. 1.9%, HR 6.00, 95% CI: 1.78-20.26, p=0.004 in non-LAD). CONCLUSIONS: Higher post-PCI FFR after second-generation DES implantation was associated with better clinical outcomes. Different cut-off values of post-PCI FFR need to be applied according to the target vessel. ClinicalTrials Identifier: NCT01873560.
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Hwang et al. (2019) studied this question.
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