6112Usefulness of the trans-stent fractional flow reserve gradient for predicting clinical outcomes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Lim ◽  
H M Yang ◽  
M H Yoon ◽  
K W Seo ◽  
B J Choi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Stent Length

Abstract Aims The clinical meaning of a trans-stent pressure gradient after DES implantation has not been estimated adequately. We evaluated the usefulness of a fractional flow reserve (FFR) gradient across the stent (ΔFFRstent) for long-term clinical outcomes after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES). Methods and results FFR pull-back and intravascular ultrasound (IVUS) were performed after successful PCI in 135 left anterior descending artery lesions. ΔFFRstent was defined as the FFR gradient across the stent. The ΔFFRstent/length was defined as the ΔFFRstent value divided by the total stent length multiplied by 10 [= (ΔFFRstent ÷ stent length) x 10]. Major adverse cardiac events (MACEs) were the composite of all-cause death, target vessel related myocardial infarction, and target lesion revascularisation. Despite successful PCI without significant complications on IVUS, ΔFFRstent >0 was observed in 98.5% of cases. ΔFFRstent ≥0.04 and ΔFFRstent/length ≥0.009 predicted suboptimal stenting defined as final minimal stent area <5.5 mm2. During 2183±898 days, the MACE-free survival rate was significantly lower in patients with ΔFFRstent ≥0.04 and ΔFFRstent/length ≥0.009 compared to those with lower values (69.6 vs. 93.4%, log-rank p=0.031; 72.1 vs. 97.7%, log-rank p=0.003, respectively). ΔFFRstent/length ≥0.009 (hazard ratio 10.1, p=0.032) was an independent predictor of MACE. Trans-stent FFR and MACE Conclusion A trans-stent FFR gradient was frequently observed in DES-treated patients despite successful PCI results. ΔFFRstent and ΔFFRstent/length are useful indicators for optimising a DES and are related to long-term outcomes.

scholarly journals Fractional Flow Reserve After Functionally Optimized Coronary Intervention Predicts Very Long-Term Outcomes

2021 ◽  
Vol 14 (3) ◽  
pp. 355-356
Author(s):  
Shiv Kumar Agarwal ◽  
Abdul Hakeem ◽  
Rimsha Hasan ◽  
Mohamed Ayan ◽  
Aisha Siraj ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Long Term Outcomes ◽  
Flow Reserve

scholarly journals Long-Term Clinical Outcomes of Fractional Flow Reserve-Guided Coronary Artery Revascularization in Chronic Kidney Disease

2022 ◽  
Vol 12 (1) ◽  
pp. 21
Author(s):  
Chien-Boon Jong ◽  
Tsui-Shan Lu ◽  
Patrick Yan-Tyng Liu ◽  
Jeng-Wei Chen ◽  
Ching-Chang Huang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Fractional Flow Reserve ◽  
Primary Endpoint ◽  
Coronary Revascularization ◽  
Fractional Flow ◽  
Flow Reserve

Fractional flow reserve (FFR)-guided percutaneous coronary intervention has shown favorable long-term clinical outcomes. However, limited data exist evaluating the FFR assessment among the chronic kidney disease (CKD) population. The aim of this study was to evaluate the long-term clinical outcomes of FFR-guided coronary revascularization in patients with CKD. A total of 242 CKD patients who underwent FFR assessment were retrospectively analyzed. Patients were divided into two groups: revascularization (FFR ≤ 0.80) and non-revascularization (FFR > 0.80). The primary endpoint was the composite of cardiac death, non-fatal myocardial infarction, and target vessel failure (TVF). The key secondary endpoint was TVF. The Cox regression model was used for risk evaluation. With 91% of the ischemic vessels revascularized, the revascularization group had higher risks for both the primary endpoint (adjusted hazard ratio [aHR]: 2.06; 95% confidence interval [CI], 1.07–3.97; p = 0.030) and key secondary endpoint (aHR: 2.19, 95% CI: 1.10–4.37; p = 0.026), during a median follow-up of 2.9 years. This result was consistent among different CKD severities. In patients with CKD, functional ischemia in coronary artery stenosis was associated with poor clinical outcomes despite coronary revascularization.

FRACTIONAL FLOW RESERVE AFTER FUNCTIONALLY OPTIMIZED CORONARY INTERVENTION (FCI) PREDICTS LONG-TERM OUTCOMES

2020 ◽  
Vol 75 (11) ◽  
pp. 1456
Author(s):  
Shiv Kumar Agarwal ◽  
Abdul Hakeem ◽  
Rimsha Hasan ◽  
Mohamed Ayan ◽  
Aisha Siraj ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Long Term Outcomes ◽  
Flow Reserve

P1251Percutaneous coronary intervention versus medical therapy for coronary lesions with positive fractional flow reserve (FFR) but preserved coronary flow reserve (CFR). A substudy of the COMPARE-ACUTE

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J D Haeck ◽  
F M Zimmermann ◽  
M Van 'T Veer ◽  
F J Neumann ◽  
A S Triantafyllis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Medical Therapy ◽  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Coronary Intervention ◽  
Pressure Gradients ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Coronary Lesions

Abstract Introduction International guidelines recommend performing percutaneous coronary intervention (PCI) on stable coronary lesions with a positive fractional flow reserve (FFR) to improve clinical outcomes. It remains unclear if FFR positive lesions with preserved coronary flow reserved (CFR) might be better treated medically. Purpose This study compared clinical outcomes between PCI and medical therapy for stable FFR-positive lesions with preserved CFR. Methods We performed a substudy of the randomized, multicenter COMPARE-ACUTE trial in which treated ST-elevation myocardial infarction patients with stable non-culprit lesions were randomized to either FFR-guided PCI or medical therapy. Based on baseline and hyperaemic pressure gradients, we computed the so-called pressure bounded-CFR (pb-CFR) and classified lesions as low (<2) or preserved (≥2). Our primary end point was a composite of death from any cause, non-fatal myocardial infarction, revascularization, or cerebrovascular events (MACCE) at 12 months. Results A total of 980 lesions from 885 subjects were included in this sub-study due to availability of baseline and hyperaemic pressure gradients. For the 462 lesions with FFR≤0.80, 249 had a pb-CFR<2 while 29 had a preserved CFR (pb-CFR≥2). The rate of MACCE at 1 year did not differ significantly between subjects with FFR≤0.80 and pb-CFR<2 versus FFR≤0.80 and pb-CFR≥2 (24% vs. 30%, p=0.44). Because of randomization, baseline characteristics were well balanced between subjects with FFR≤0.80 and pb-CFR≥2 who were treated by PCI or medical therapy. Importantly for subjects with FFR≤0.80 and pb-CFR≥2, MACCE occurred more frequently when treated medically compared with PCI (50% vs. 0% respectively, p=0.01). Conclusions In this post-hoc substudy from a large randomized controlled trial of 885 subjects with 980 lesions, a preserved pb-CFR≥2 did not associate with an improved clinical outcome when FFR≤0.80. Subjects with FFR-positive coronary lesions but a preserved pb-CFR experienced significantly worse clinical outcomes when treated medically instead of with PCI. These data suggest that a stenosis with a FFR≤0.80, even when pb-CFR remains preserved, benefits from treatment with PCI. Acknowledgement/Funding Maasstad Cardiovascular Research, Abbott Vascular and St. Jude Medical

Abstract 14304: Assessing the Association of Adherence to Fractional Flow Reserve Treatment Thresholds and Outcomes of Patients With Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Maneesh Sud ◽  
Lu Han ◽  
Maria Koh ◽  
Peter Austin ◽  
Michael E Farkouh ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Routine Practice ◽  
Cardiac Events ◽  
Fractional Flow ◽  
St Segment Elevation ◽  
Single Vessel ◽  
Flow Reserve

Background: Although fractional flow reserve (FFR) thresholds have been established to guide the use of percutaneous coronary intervention (PCI) or medical therapy, little is known about the adherence to FFR thresholds for PCI in clinical practice and their association with clinical outcomes. Methods: Adults undergoing FFR assessment in a single vessel (excluding ST-segment elevation myocardial infarction [MI]) from April 1, 2013 to March 31, 2018 in Ontario, Canada were included. Patients were divided into two cohorts based on FFR ≤ 0.80 (ischemic) and > 0.80 (non-ischemic). Inverse probability of treatment weighting was used to balance confounders between patients treated with PCI vs. no PCI in each cohort. The primary outcome was major adverse cardiac events (MACE) defined by death, MI, unstable angina, or urgent revascularization. Results: We identified 9,106 patients who underwent single-vessel FFR measurement. Among the 2,693 patients with an ischemic FFR (mean age 65, 27.0% female), 75.3% of patients received PCI and 24.7% were treated only with medical therapy. Over a median follow-up of 2.6 years in the ischemic cohort, PCI was associated with a 20% lower rate of MACE compared to no PCI (24.0% vs. 31.6%; hazard ratio [HR]: 0.80, 95% CI: 0.66-0.96). However, among 6,413 patients with a non-ischemic FFR (mean age 66, 38.9% female), 12.6% received PCI and 87.4% were treated only with medical therapy. Over a median follow-up of 2.8 years in the non-ischemic cohort, PCI was associated with a 42% higher rate of MACE compared to no PCI (25.6% vs. 17.6%; HR: 1.42, 95% CI: 1.18-1.70). The increased rate of MACE was driven mainly by MI (HR 1.67, 95% CI: 1.20-2.31) but not death (HR 0.99, 95% CI: 0.72-1.35). Conclusions: In routine practice, we found 1 in 4 patients did not receive PCI for ischemic lesions while 1 in 8 received PCI for non-ischemic lesions. Performing PCI procedures according to recommended FFR cutoffs was associated with lower rates of clinical events.

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