Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction.

Background

Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified.

Objectives

This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF).

Methods

A total of 2,965 patients with available LVEF were selected from the POST-PCI FLOW (Prognostic Implications of Physiologic Investigation After Revascularization with Stent) international registry of patients with post-PCI FFR measurement. The primary outcome was a composite of cardiac death or target-vessel myocardial infarction (TVMI) at 2 years. The secondary outcome was target-vessel revascularization (TVR) and target vessel failure, which was a composite of cardiac death, TVMI, or TVR.

Results

Post-PCI FFR was independently associated with the risk of target vessel failure (per 0.01 decrease: HR

Conclusions

Post-PCI FFR had differential prognostic impact according to LVEF. Residual ischemia by post-PCI FFR ≤0.80 was a prognostic indicator for cardiac death or TVMI among patients with patients with LVEF ≤40%, and it was associated with TVR among patients with patients with LVEF>40%. (Prognostic Implications of Physiologic Investigation After Revascularization with Stent [POST-PCI FLOW]; NCT04684043).

Informations de copyright

© 2024 The Authors.

Déclaration de conflit d'intérêts

Dr Joo Myung Lee has received an institutional research grant from Abbott Vascular, Boston Scientific, Philips Volcano, Terumo Corporation, Donga-ST, and Zoll Medical. Dr Bon-Kwon Koo has received an institutional research grant from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr Joon Hyung Doh has received a research grant from Philips Volcano. Dr Shao-Liang Chen is a consultant for Microport and Boston Scientific International; and has received a grant from the National Natural Scientific Foundation of China. Dr Toth receives consultancy fees and unrestricted research grants from Abbott, Medtronic, and Terumo. Dr Johnson has received institutional research support from Volcano/Philips (DEFINE-FLOW, NCT02328820), Abiomed (for study of Impella-related coronary physiology) and St. Jude Medical (CONTRAST, NCT02184117); has an institutional licensing agreement with Boston Scientific for the smart-minimum FFR algorithm commercialized under 510(k) K191008; and has pending patents on diagnostic methods for quantifying aortic stenosis and TAVR physiology, and also algorithms to correct pressure tracings from fluid-filled catheters. Dr Leesar has received an institutional research grant from ACIST. Dr Azzalini has received honoraria from Teleflex, Abiomed, GE Healthcare, Asahi Intecc, Philips, Abbott Vascular, and Cardiovascular System, Inc. Dr Diletti has received an institutional research grant to Erasmus University Medical Center; and has served as a consultant to ACIST Medical Systems. Dr Collison has received consultancy/speaker fees from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.