Author + information
- Rutger van Bommel1,
- Roberto Diletti2,
- Miguel Lemmert3,
- Jeroen Wilschut3,
- Peter P.T. De Jaegere4,
- Felix Zijlstra5,
- Joost Daemen6 and
- Nicolas Van Mieghem7
- 1Erasmus MC, Rotterdam, Netherlands
- 2Thorax Center, Erasmus MC, Rotterdam, Netherlands
- 3Thoraxcenter Erasmus MC, Rotterdam, Netherlands
- 4Erasmus MC, Rotterdam, The Netherlands, Rotterdam, Netherlands
- 5Thoraxcenter, Erasmus Medical Centre, Rotterdam, Netherlands
- 6Erasmus MC - Thoraxcenter, United States
- 7Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
Fractional Flow Reserve (FFR) after PCI is a predictor of late adverse cardiovascular events. Most studies only included patients with stable coronary lesions and therefore not much is known about post-PCI FFR values in patients presenting with ST elevation myocardial infarction (STEMI) or NSTEMI. We therefore sought to investigate the differences in FFR after successful PCI in patients with stable angina, NSTEMI or STEMI and to see if there is a difference in MACE at 30-days follow-up.
The FFR SEARCH study is a prospective registry in which all consecutive patients underwent FFR evaluation after successful PCI. FFR measurements were performed with a novel over-the-wire monorail catheter inserted over the previously used coronary guidewire to approximately 20mm distal of the most distal stent edge. FFR measurements were performed under maximum hyperaemia with intravenous Adenosine.
A total of 959 patients (285 with stable angina, 352 presenting with a NSTEMI and 322 with a STEMI) were included with 1165 successfully treated and measured lesions. Overall, mean FFR under maximum hyperaemia was 0.91±0.07. A significant differences in post PCI FFR was observed between the groups, with an average FFR in STEMI patients of 0.93±0.06, while the average FFR in patients presenting with a NSTEMI was 0.90±0.06 and the average FFR in patients with stable angina 0.89±0.07, p<0.001. Post-hoc analysis showed that these differences were significant for all subgroup analyses (p<0.001 in patients with STEMI vs. patients with stable angina and in STEMI patients vs. patients presenting with a NSTEMI and p=0.031 in NSTEMI patients vs. patients with stable angina). In 798 patients, complete 30-days follow-up was available. In this period, 15 patients (1.9%) experienced a MACE. There were no differences in MACE-rate between patients with stable angina, NSTEMI and STEMI (0.8% vs 2.7% vs. 2.0%, p=0.248).
In patients presenting with STEMI, FFR values measured directly following successful PCI are significantly higher than in patients with NSTEMI or stable angina. Despite these differences, MACE-rate during 30-days follow-up is comparable between the 3 groups.
IMAGING: FFR and Physiologic Lesion Assessment