The prognostic value of angiography-based vessel fractional flow reserve after percutaneous coronary intervention: The FAST Outcome study

• Published in: International journal of cardiology Vol. 359; pp. 14 - 19
• Main Authors: Neleman, Tara, Scoccia, Alessandra, Masdjedi, Kaneshka, Tomaniak, Mariusz, Ligthart, Jurgen M.R., Witberg, Karen T., Vermaire, Alise, Wolff, Quinten, Visser, Leon, Cummins, Paul, Kardys, Isabella, Wilschut, Jeroen, Diletti, Roberto, Den Dekker, Wijnand K., Zijlstra, Felix, Van Mieghem, Nicolas M., Daemen, Joost
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.07.2022
• Subjects: Coronary physiology; Fractional flow reserve; Percutaneous coronary intervention; Quantitative coronary angiography; Vessel fractional flow reserve; Vessel fractional flow reserve; Quantitative coronary angiography; Percutaneous coronary intervention; Coronary physiology; Fractional flow reserve
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2022.04.021

Vessel Fractional Flow Reserve (vFFR) as assessed by three-dimensional quantitative coronary angiography has high correlation with pressure wire-based fractional flow reserve in both a pre- and post-PCI setting. The present study aims to assess the prognostic value of post-PCI vFFR on the incidence of target vessel failure (TVF), a composite endpoint of cardiac death, target vessel myocardial infarction and target vessel revascularization (TVR) at 5-year follow up. Post-PCI vFFR was calculated after routine PCI in a total of 748 patients (832 vessels) with available orthogonal angiographic projections of the stented segment. Median age was 65 (IQR 55–74) years, 18.2% were diabetic, and 29.1% presented with stable angina. Median post-PCI vFFR was 0.91 (IQR 0.86–0.95). Vessels were categorized into tertiles based on post-PCI vFFR: low (vFFR <0.88), middle (vFFR 0.88–0.93), and upper (vFFR ≥0.94). Vessels in the lower and middle tertile were more often LADs and had smaller stent diameters (p<0.001). Vessels in the lower and middle tertile had a higher risk of TVF as compared to vessels in the upper tertile (24.6% and 21.5% vs. 17.1%; adjusted HR 1.84 (95%CI 1.15–2.95), p = 0.011, and 1.58 (95%CI 1.02–2.45), p = 0.040) at 5-years follow-up. Additionally, vessels in the lower tertile had higher rates of TVR as compared to vessels in the higher tertile (12.6% vs. 6.5%, adjusted HR 1.93 (95%CI 1.06–3.53), p = 0.033). Lower post-PCI vFFR values are associated with a significantly increased risk of TVF and TVR at 5-years follow-up. •Suboptimal post-PCI FFR is related to an increased risk of cardiovascular events.•vFFR, an angiography-derived FFR index, correlates strongly with invasive FFR.•Lower post-PCI vFFR values were found more often in LAD vessels and smaller stents.•Lower post-PCI vFFR values had higher rates of target vessel failure at 5-years.•Post-PCI vFFR might identify those who require additional post-PCI optimization.