Korean Circ J.  2022 Jan;52(1):47-59. 10.4070/kcj.2021.0128.

Differential Prognostic Implications of Pre- and Post-Stent Fractional Flow Reserve in Patients Undergoing Percutaneous Coronary Intervention

• Zhang J
• Hwang D
• Yang S
• Kim CH
• Lee JM
• Nam CW
• Shin ES
• Doh JH
• Hoshino M
• Hamaya R
• Kanaji Y
• Murai T
• Zhang JJ
• Ye F
• Li X
• Ge Z
• Chen SL
• Kakuta T
• Koo BK

• KMID: 2524169
• DOI: http://doi.org/10.4070/kcj.2021.0128

Abstract

Background and Objectives
The influence of pre-intervention coronary physiologic status on outcomes post percutaneous coronary intervention (PCI) is not well known. We sought to investigate the prognostic implications of pre-PCI fractional flow reserve (FFR) combined with post-PCI FFR.
Methods
A total of 1,479 PCI patients with pre-and post-PCI FFR data were analyzed. The patients were classified according to the median values of pre-PCI FFR (0.71) and post-PCI FFR (0.88). The primary outcome was target vessel failure (TVF) at 2 years.
Results
The risk of TVF was higher in the low pre-PCI FFR group than in the high pre-PCI FFR group (hazard ratio, 1.82; 95% confidence interval, 1.15–2.87; p=0.011). In 4 group comparisons, the cumulative incidences of TVF at 2 years were 3.8%, 4.1%, 4.8%, and 10.2% in the high pre-/high post-, low pre-/high post-, high pre-/low post-, and low pre-/low post-PCI FFR groups, respectively. The risk of TVF was the highest in the low pre-/low post-PCI FFR group among the groups (p values for comparisons <0.05). In addition, the high pre-/low post-PCI FFR group presented a comparable risk of TVF with the high post-PCI FFR groups (p values for comparison >0.05). When the prognostic value of the post-PCI FFR was evaluated according to the pre-PCI FFR, the risk of TVF significantly decreased with an increase in postPCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group.
Conclusions
Pre-PCI FFR was associated with clinical outcomes after PCI, and the prognostic value of post-PCI FFR differed according to the pre-PCI FFR.

Keyword

Coronary artery disease; Percutaneous coronary intervention; Prognosis

Figure

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  Figure 1 Cumulative incidence of target vessel failure. The Kaplan-Meier estimates of target vessel failure according to pre-PCI FFR (A) and post-PCI FFR (B) are shown. The patients were grouped according to median pre-PCI (0.71) and post-PCI (0.88) FFR values.CI = confidence interval; FFR = fractional flow reserve; HR = hazard ratio; PCI = percutaneous coronary intervention.

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  Figure 2 Cumulative incidence of target vessel failure in 4 groups according to pre-and post-PCI FFR. The patients were classified according to the median values of pre- (0.71) and post-PCI (0.88) FFR. Kaplan Meir estimates of these 4 groups are presented, and the low pre-/low post-PCI FFR group showed the highest cumulative incidence of target vessel failure at 2 years.FFR = fractional flow reserve; PCI = percutaneous coronary intervention.

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  Figure 3 Association between the estimated risk of clinical events and post-PCI FFR according to pre-PCI FFR. The estimated risks of clinical events at 2 years were plotted according to the post-PCI FFR. The risk of target vessel failure (A) and target lesion revascularization in the non-stented segment (C) decreased along with the increase of post-PCI FFR in the low-pre PCI FFR (≤0.71) group but not in the high-pre PCI FFR (>0.71) group. The risk of target lesion revascularization (B) was not associated with post-PCI FFR regardless of pre-PCI FFR values.CI = confidence interval; FFR = fractional flow reserve; HR = hazard ratio; PCI = percutaneous coronary intervention.

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