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Prognostic value of fractional flow reserve measured immediately after drug-eluting stent implantation

Prognostic value of fractional flow reserve measured immediately after drug-eluting stent implantation
Prognostic value of fractional flow reserve measured immediately after drug-eluting stent implantation

BACKGROUND: The predictive value of fractional flow reserve (FFR) measured immediately after percutaneous coronary intervention (PCI) with drug-eluting stent placement has not been prospectively investigated. We investigated the potential of post-PCI FFR measurements to predict clinical outcome in patients from FAME 1 and 2 trials (Fractional Flow Reserve or Angiography for Multivessel Evaluation).

METHODS AND RESULTS: All patients of FAME 1 and FAME 2 who had post-PCI FFR measurement were included. The primary outcome was vessel-oriented composite end point at 2 years, defined as vessel-related cardiovascular death, vessel-related spontaneous myocardial infarction, and ischemia-driven target vessel revascularization. Eight hundred thirty-eight vessels in 639 patients were analyzed. Baseline FFR values did not differ between vessels with versus without vessel-oriented composite end point (0.66±0.11 versus 0.63±0.14, respectively; P=0.207). Post-PCI FFR was significantly lower in vessels with vessel-oriented composite end point (0.88±0.06 versus 0.90±0.06, respectively; P=0.019). Comparing the 2-year outcome of lower and upper tertiles of post-PCI FFR significant difference was found favoring upper tertile in terms of overall vessel-oriented composite end point (9.2% versus 3.8%, respectively; hazard ratio, 1.46; 95% confidence interval, 1.02-2.08; P=0.037) and target vessel revascularization (7.0% versus 2.4%, respectively; hazard ratio, 1.59; 95% confidence interval, 1.03-2.46; P=0.037). When adjusted to sex, hypertension, diabetes mellitus, target vessel, serial stenosis, and baseline percentage diameter stenosis, a strong trend was preserved in terms of target vessel revascularization (harzard ratio, 1.55; 95% confidence interval, 0.97-2.46; P=0.066), favoring the upper tertile. Post-PCI FFR of 0.92 was found to have the highest diagnostic accuracy; however, the positive likelihood ratio remained low (<1.4).

CONCLUSIONS: A higher post-PCI FFR value is associated with a better vessel-related outcome. However, its predictive value is too low to advocate its use as a surrogate clinical end point.

Aged, Cohort Studies, Drug-Eluting Stents, Female, Fractional Flow Reserve, Myocardial, Humans, Male, Middle Aged, Percutaneous Coronary Intervention, Predictive Value of Tests
1941-7640
Piroth, Zsolt
987ac008-d51d-4a12-a67c-499766e2fba5
Toth, Gabor G.
af8702a6-1b7d-4eea-92d0-39e3c3dce06a
Tonino, Pim A.L.
f22d79b3-5ee7-4780-b25c-df728ce09a3b
Barbato, Emanuele
50106486-a9cd-4c08-9ee7-74d049a9356d
Aghlmandi, Soheila
3ac6ce63-802e-4c2d-a58a-02e2e5397719
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Rioufol, Gilles
87163c97-9ed4-477a-9692-6ac8506fcd9f
Pijls, Nico H.J.
90717d6e-0756-4d55-ba7f-d4f7377ea048
Fearon, William F
0cd8b847-758f-4501-bd76-543e630f3179
Jüni, Peter
1448ad34-a0d4-4faa-962b-abf202246167
De Bruyne, Bernard
6c86ad29-d853-4e59-9633-f536a17efd4e
Piroth, Zsolt
987ac008-d51d-4a12-a67c-499766e2fba5
Toth, Gabor G.
af8702a6-1b7d-4eea-92d0-39e3c3dce06a
Tonino, Pim A.L.
f22d79b3-5ee7-4780-b25c-df728ce09a3b
Barbato, Emanuele
50106486-a9cd-4c08-9ee7-74d049a9356d
Aghlmandi, Soheila
3ac6ce63-802e-4c2d-a58a-02e2e5397719
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Rioufol, Gilles
87163c97-9ed4-477a-9692-6ac8506fcd9f
Pijls, Nico H.J.
90717d6e-0756-4d55-ba7f-d4f7377ea048
Fearon, William F
0cd8b847-758f-4501-bd76-543e630f3179
Jüni, Peter
1448ad34-a0d4-4faa-962b-abf202246167
De Bruyne, Bernard
6c86ad29-d853-4e59-9633-f536a17efd4e

Piroth, Zsolt, Toth, Gabor G., Tonino, Pim A.L., Barbato, Emanuele, Aghlmandi, Soheila, Curzen, Nick, Rioufol, Gilles, Pijls, Nico H.J., Fearon, William F, Jüni, Peter and De Bruyne, Bernard (2017) Prognostic value of fractional flow reserve measured immediately after drug-eluting stent implantation. Circulation. Cardiovascular interventions, 10 (8), [e005233]. (doi:10.1161/CIRCINTERVENTIONS.116.005233).

Record type: Article

Abstract

BACKGROUND: The predictive value of fractional flow reserve (FFR) measured immediately after percutaneous coronary intervention (PCI) with drug-eluting stent placement has not been prospectively investigated. We investigated the potential of post-PCI FFR measurements to predict clinical outcome in patients from FAME 1 and 2 trials (Fractional Flow Reserve or Angiography for Multivessel Evaluation).

METHODS AND RESULTS: All patients of FAME 1 and FAME 2 who had post-PCI FFR measurement were included. The primary outcome was vessel-oriented composite end point at 2 years, defined as vessel-related cardiovascular death, vessel-related spontaneous myocardial infarction, and ischemia-driven target vessel revascularization. Eight hundred thirty-eight vessels in 639 patients were analyzed. Baseline FFR values did not differ between vessels with versus without vessel-oriented composite end point (0.66±0.11 versus 0.63±0.14, respectively; P=0.207). Post-PCI FFR was significantly lower in vessels with vessel-oriented composite end point (0.88±0.06 versus 0.90±0.06, respectively; P=0.019). Comparing the 2-year outcome of lower and upper tertiles of post-PCI FFR significant difference was found favoring upper tertile in terms of overall vessel-oriented composite end point (9.2% versus 3.8%, respectively; hazard ratio, 1.46; 95% confidence interval, 1.02-2.08; P=0.037) and target vessel revascularization (7.0% versus 2.4%, respectively; hazard ratio, 1.59; 95% confidence interval, 1.03-2.46; P=0.037). When adjusted to sex, hypertension, diabetes mellitus, target vessel, serial stenosis, and baseline percentage diameter stenosis, a strong trend was preserved in terms of target vessel revascularization (harzard ratio, 1.55; 95% confidence interval, 0.97-2.46; P=0.066), favoring the upper tertile. Post-PCI FFR of 0.92 was found to have the highest diagnostic accuracy; however, the positive likelihood ratio remained low (<1.4).

CONCLUSIONS: A higher post-PCI FFR value is associated with a better vessel-related outcome. However, its predictive value is too low to advocate its use as a surrogate clinical end point.

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More information

Accepted/In Press date: 26 June 2017
e-pub ahead of print date: 8 August 2017
Published date: August 2017
Keywords: Aged, Cohort Studies, Drug-Eluting Stents, Female, Fractional Flow Reserve, Myocardial, Humans, Male, Middle Aged, Percutaneous Coronary Intervention, Predictive Value of Tests

Identifiers

Local EPrints ID: 435516
URI: http://eprints.soton.ac.uk/id/eprint/435516
ISSN: 1941-7640
PURE UUID: 1879e56d-783c-4950-a249-82a45f3487f6
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 08 Nov 2019 17:30
Last modified: 17 Mar 2024 03:02

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Contributors

Author: Zsolt Piroth
Author: Gabor G. Toth
Author: Pim A.L. Tonino
Author: Emanuele Barbato
Author: Soheila Aghlmandi
Author: Nick Curzen ORCID iD
Author: Gilles Rioufol
Author: Nico H.J. Pijls
Author: William F Fearon
Author: Peter Jüni
Author: Bernard De Bruyne

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