Post-PCI FFR cutoff values for predicting target vessel failure are vessel-specific: 0.86 for LAD and 0.93 for non-LAD vessels in 2128 patients.
Do target vessel-specific post-PCI fractional flow reserve (FFR) cutoff values improve prognostic prediction of target vessel failure at 5 years in patients after successful DES implantation?
Optimal post-PCI FFR cutoff values for predicting long-term outcomes are vessel-dependent, with lower thresholds for LAD (0.86) compared to non-LAD vessels (0.93).
Absolute Event Rate: 0% vs 0%
Abstract Background Post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) is an established prognostic physiological marker after revascularization, used to assess stenting success and predict long-term outcomes. While post-PCI FFR's prognostic value is recognized, its optimal cutoff value has shown considerable variability across studies. We hypothesized that this variability may be partly explained by differences in perfused myocardial mass between the left anterior descending artery (LAD) and non-LAD territories. Purpose We aimed to investigate the vessel-specific prognostic cutoff value of post-PCI FFR. Methods This subanalysis of the International Post-PCI FFR Extended Registry included 2128 patients who underwent successful drug-eluting stent (DES) implantation. Post-PCI FFR was measured immediately after the procedure, and patients were stratified according to the target vessel (LAD or non-LAD). The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction, and target vessel revascularization at 5 years. Hazard ratios (HRs) for TVF were calculated per 0.01 unit decrease in post-PCI FFR using univariate and multivariate Cox proportional hazards models. Results The median post-PCI FFR overall was 0.88 (LAD: 0.87 vs. non-LAD: 0.94). A significant inverse relationship was observed between post-PCI FFR and TVF risk. Restricted cubic spline analysis identified vessel-specific optimal post-PCI FFR cutoff values: 0.86 for LAD and 0.93 for non-LAD vessels, with the LAD cutoff being significantly lower (p0.05). Multivariate analysis confirmed these findings, showing similar optimal cutoff values (LAD: 0.87 vs. non-LAD: 0.93) after adjusting for confounders. Conclusion These results demonstrate that optimal post-PCI FFR cutoff values are vessel-dependent, emphasizing the importance of vessel-specific risk stratification and tailored post-PCI management strategies.Figure1:Histogram of post-PCI FFR
Kanaji et al. (Sat,) reported a other. Post-PCI FFR cutoff values for predicting target vessel failure are vessel-specific: 0.86 for LAD and 0.93 for non-LAD vessels in 2128 patients.