Prognostic factors after FFR-guided PCI in diffuse long coronary lesions: the value of post-PCI fractional flow reserve

Objectives: To identify prognostic factors influencing clinical outcomes after fractional flow reserve (FFR)guided percutaneous coronary intervention (PCI) in patients with diffuse long coronary lesions, and to determine the prognostic value of post-PCI FFR.Methods: This retrospective study enrolled 327 patients with diffuse coronary lesions (≥20 mm) who underwent FFR-guided PCI between January 2018 and December 2022.FFR was measured using a 0.014-inch pressure wire during maximal adenosine-induced hyperemia, calculated as the ratio of mean distal coronary pressure to mean aortic pressure.Post-PCI FFR was recorded with the sensor positioned ≥10 mm distal to the stented segment.The primary endpoint was major adverse cardiovascular events (MACE), comprising target lesion revascularization, target vessel myocardial infarction, and cardiac death.Independent predictors were identified using multivariate Cox regression.Results: During a median follow-up of 24 months, 57 patients (17.4%) experienced MACE.Five independent predictors were identified: suboptimal post-PCI FFR <0.90 (hazard ratio [HR], 2.68; 95% confidence interval [CI], 1.78-4.02;P<0.001), lesion length ≥30 mm (HR, 1.95; P=0.002), diabetes mellitus (HR, 1.84; P=0.003), severe calcification requiring plaque modification (HR, 1.78; P=0.004), and baseline FFR ≤0.60 (HR, 1.64; P=0.012).Achieving optimal post-PCI FFR (≥0.90) reduced MACE risk by 63%.Conclusions: Post-PCI FFR is the strongest predictor of long-term outcomes after FFR-guided PCI for diffuse long lesions.Achieving post-PCI FFR ≥0.90 should be a procedural target, which supports a physiology-guided optimization strategy to improve prognosis.