Key result
Lower post-PCI Fractional Flow Reserve was an independent predictor of target vessel failure, with optimal predictive cut-off values of 0.83 for LAD vessels and 0.91 for non-LAD vessels.
Why the study?
The study sought to identify independent predictors of post-PCI FFR and examine whether applying vessel-specific post-PCI FFR cut-off values improves the prediction of clinical outcomes including target vessel failure.
Does post-PCI FFR predict target vessel failure in patients undergoing PCI with drug-eluting stents?
Observational (n=434)
No
Does post-PCI FFR predict target vessel failure in patients undergoing PCI with drug-eluting stents?
p-value: p=<0.001
Post-PCI FFR independently predicts target vessel failure, but optimal prognostic cut-off values differ significantly between LAD (0.83) and non-LAD (0.91) vessels.
PURPOSE: The purpose of the present study was to find the independent predictors of Fractional Flow Reserve (FFR) measured immediately after percutaneous coronary intervention with drug-eluting stent implantation (post-PCI FFR) and investigate if applying vessel-specific post-PCI FFR cut-off values to predict target vessel failure (TVF), a composite of cardiac death (CD), non-fatal myocardial infarction (MI) and target vessel revascularization (TVR), or a composite of CD and MI ameliorated its predictive power. METHODS: Consecutive patients with post-PCI FFR measurement at our center between 2009 and 2021 were included in this analysis. RESULTS: A total of 434 patients with 500 vessels were included. Median pre-PCI FFR was 0.72 with no difference between LAD and non-LAD vessels. Median post-PCI FFR was 0.87. LAD location, male gender, smaller stent diameter, and lower pre-PCI FFR proved to be significant predictors of a lower post-PCI FFR. On a vessel-level, post-PCI FFR, stent length, and diabetes mellitus proved to be significant predictors of TVF and the composite of CD and MI. The best post-PCI FFR cut-off to predict TVF or a composite of CD and MI was 0.83 in the LAD and 0.91 in non-LAD vessels. CONCLUSION: LAD location is a predictor of a lower post-PCI FFR. Post-PCI FFR is an independent predictor of TVF as well as of the composite of CD and MI. No uniform target post-PCI FFR value exists; different cut-off values may have to be applied in LAD as opposed to non-LAD vessels.
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Csanádi et al. (2023) conducted an observational in Coronary Artery Disease (n=434). Post-PCI Fractional Flow Reserve (FFR) vs. Higher vs lower post-PCI FFR values was evaluated on Target vessel failure (TVF), a composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization (p=<0.001). Lower post-PCI Fractional Flow Reserve was an independent predictor of target vessel failure, with optimal predictive cut-off values of 0.83 for LAD vessels and 0.91 for non-LAD vessels.
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