Utilizing Post-Intervention Fractional Flow Reserve to Optimize Acute Results and the Relationship to Long-Term Outcomes

Abstract

Objectives: This study sought to evaluate the impact of fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) on subsequent in-lab interventional management vessels that had undergone pre-PCI FFR and its prognostic value in predicting long-term (>1 year) outcomes.

Background: Post-PCI FFR has been shown to be a predictor of intermediate-term (6 months) adverse events. However, its impact on immediate post procedure clinical decision making and long-term outcomes is not known.

Methods: Consecutive patients undergoing PCI who had pre- and post-PCI FFR evaluations were followed for major adverse cardiovascular events (MACE).

Results: In the study 574 patients (664 lesions) were followed for 31 ± 16 months. PCI led to significant improvement in FFR from 0.65 ± 0.14 to 0.87 ± 0.08 (p < 0.0001). Despite satisfactory angiographic appearance, 143 lesions (21%) demonstrated post-PCI FFR in the ischemic range (FFR ≤0.81). After subsequent interventions, FFR in this subgroup increased from 0.78 ± 0.08 to 0.87 ± 0.06 (p < 0.0001). Final FFR cutoff of ≤0.86 had the best predictive accuracy for MACE and ≤0.85 for TVR. Patients who achieved final FFR >0.86 had significantly lower MACE compared to the final FFR ≤0.86 group (17% vs. 23%; log-rank p = 0.02). Final FFR ≤0.86 had incremental prognostic value over clinical and angiographic variables for MACE prediction.

Conclusions: Post-PCI FFR reclassified 20% of angiographically satisfactory lesions, which required further intervention thereby providing an opportunity for complete functional optimization at the time of the index procedure. This is particularly important as FFR post-PCI FFR was a powerful independent predictor of long-term outcomes.

Keywords: fractional flow reserve; functional optimization; major adverse cardiovascular outcomes; percutaneous coronary intervention; prognosis.