Author + information
- Kaneshka Masdjedi1,
- Jurgen Ligthart1,
- Karen Witberg1,
- Mariusz Tomaniak2,
- Laurens Zandvoort3,
- Roberto Diletti4,
- Felix Zijlstra4,
- Nicolas Van Mieghem4 and
- Joost Daemen4
- 1Erasmus Medical Center, Rotterdam, the Netherlands
- 2Thorax Center, Erasmus MC, Department of Interventional Cardiology, Rotterdam, the Netherlands, and Medical University of Warsaw, First Department of Cardiology, Warsaw, Poland
- 3EMC, Rotterdam, the Netherlands
- 4Thorax Center, Erasmus MC, Rotterdam, the Netherlands
Vessel fractional flow reserved (vFFR) as assessed by 3-dimensional quantitative coronary angiography (3D-QCA) proved to have a high correlation with pressure wire–based FFR in both a pre– and post–percutaneous coronary intervention (PCI) setting. The present study aims to assess the predictive value of post-PCI vFFR on the incidence of major adverse cardiovascular events (MACE), a combined endpoint of cardiac death, myocardial infarction, and target vessel revascularization (TVR), at 1-year follow-up.
The present study is a post hoc analysis of the P-Search study population, which was a single-center, prospective all-comer cohort study comparing 1-year clinical outcome data of patients treated with either durable polymer paclitaxel- or everolimus-eluting stents between 2012 and 2014 (n = 2,000). Post-PCI vFFR using CAAS Workstation (Pie Medical Imaging, Maastricht, the Netherlands) was calculated in a total of 810 patients with angiographically successful PCI (Thrombolysis In Myocardial Infarction grade 3 flow and final residual diameter stenosis <30%) as determined by 2 orthogonal angiographic projections of the stented segment.
Mean age was 64 ± 12 years; 18% had diabetes, 51% had hypertension, and 34% presented with an acute myocardial infarction (ST-segment elevation myocardial infarction). Mean post-PCI vFFR was 0.90 ± 0.09. Despite angiographically good results, 37% of patients had a vFFR of ≤0.90 (n = 298) and 12% had a post-PCI vFFR ≤0.80. The cumulative incidence of MACE was 8.5% in patients with a final post-PCI vFFR ≤0.90 compared with 5.5% in patients with a post-PCI vFFR >0.90 (p = 0.10), adjusted hazard ratio (HR): 0.63 (0.34 to 1.14; p = 0.12). TVR rates were higher in patients with a final post-PCI vFFR ≤0.90 compared with those with a vFFR >0.90 (4.2% vs. 1.8%; p = 0.045), HR: 0.53 (0.20 to 1.39; p = 0.20).
Despite angiographically successful PCI results, 37% of the stented vessels end with a post-PCI vFFR ≤0.90. There was a strong trend toward higher rates of future adverse events when post-PCI vFFR was ≤0.90.
IMAGING: Physiological Lesion Assessment