Key result
Residual post-PCI vFFR <0.90 is linked to ~2.7-fold higher 5-year target vessel failure.
Why the study?
The clinical significance of residual vessel fractional flow reserve (vFFR) after PCI remains unclear despite validation against invasive post-PCI FFR.
Does a predicted residual vFFR <0.90 compared to ≥0.90 predict target vessel failure at 5 years in patients undergoing angiographically successful PCI?
Cohort (n=279)
Does a predicted residual vFFR <0.90 compared to ≥0.90 predict target vessel failure at 5 years in patients undergoing angiographically successful PCI?
A pre-procedural virtual stenting simulation yielding a residual vFFR <0.90 is associated with significantly higher rates of target vessel failure at 5 years compared to patients with vFFR ≥0.90.
Answers are grounded in this paper and cite their sources.
Residual vFFR may aid post-PCI risk stratification; hypothesis-generating and should not change practice pending prospective validation.
Backgrounds Vessel fractional flow reserve (vFFR) allows angiography-based physiological lesion evaluation and virtual percutaneous coronary intervention (PCI) simulation, estimating post-PCI vFFR (residual vFFR). While residual vFFR has been validated against invasive post-PCI fractional flow reserve (FFR), its clinical significance remains unclear. To assess the impact of residual vFFR on long-term clinical outcomes. Methods FAST Residual is a post hoc analysis of the FFR SEARCH study including 279 patients with (un)stable angina or non-ST-segment elevation myocardial infarction undergoing angiographically successful PCI. Residual vFFR was calculated based on two pre-procedural angiographic views. The primary endpoint was target vessel failure (TVF) at 5 years, a composite of cardiac death, target vessel myocardial infarction (TVMI) and target vessel revascularization (TVR). Results Mean age was 64 ± 11 years, 68.5% were men, 23.7% had diabetes, and 43.7% presented with stable angina. Median residual vFFR was 0.92 [IQR 0.87–0.95] and post-PCI FFR was 0.90 [0.85–0.94] ( r = 0.509, p < 0.001). The optimal cutoff value of residual vFFR to predict 5-year TVF was <0.90. TVF occurred in 24 (23.3%) patients in the residual vFFR <0.90 group, compared with 16 (9.1%) in the residual vFFR ≥0.90 group (adjusted HR 2.66, 95% CI 1.41–5.04; p = 0.003). This difference was driven by higher rates of TVR [16 (15.5%) vs. 12 (6.8%); adjusted HR 2.33, 95% CI 1.10–4.94; p = 0.027]. Conclusions The concept of virtual stenting is a promising tool for predicting clinical outcomes. For the first time, this post hoc analysis showed that patients with residual vFFR <0.90 experienced significantly higher rates of TVF at 5 years.
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Sadowski et al. (2026) conducted a cohort in (un)stable angina or non-ST-segment elevation myocardial infarction (n=279). Residual vessel fractional flow reserve (vFFR) <0.90 vs. Residual vFFR ≥0.90 was evaluated on Target vessel failure (TVF) at 5 years, a composite of cardiac death, target vessel myocardial infarction (TVMI) and target vessel revascularization (TVR) (adjusted HR 2.66, 95% CI 1.41-5.04, p=0.003). Patients with residual vFFR <0.90 after PCI experienced higher 5-year target vessel failure rates than those with ≥0.90 (23.3% vs 9.1%; adjusted HR 2.66; 95% CI 1.41-5.04; P=0.003).
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