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

Ki Hong Choi, Woochan Kwon, Doosup Shin, Seung Hun Lee, Doyeon Hwang, Jinlong Zhang, Chang Wook Nam, Eun Seok Shin, Joon Hyung Doh, Shao Liang Chen, Tsunekazu Kakuta, Gabor G. Toth, Zsolt Piroth, Abdul Hakeem, Barry F. Uretsky, Yohei Hokama, Nobuhiro Tanaka, Hong Seok Lim, Tsuyoshi Ito, Akiko MatsuoLorenzo Azzalini, Massoud A. Leesar, Joost Daemen, Damien Collison, Carlos Collet, Bernard De Bruyne, Bon Kwon Koo, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Joo Yong Hahn, Seung Hyuk Choi, Hyeon Cheol Gwon, Joo Myung Lee*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
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Abstract

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: HRadj: 1.029; 95% CI: 1.009-1.049; P = 0.005). Post-PCI FFR was associated with increased risk of cardiac death or TVMI (HRadj: 1.145; 95% CI: 1.025-1.280; P = 0.017) among patients with LVEF ≤40%, and with that of TVR in patients with LVEF >40% (HRadj: 1.028; 95% CI: 1.005-1.052; P = 0.020). Post-PCI FFR ≤0.80 was associated with increased risk of cardiac death or TVMI in the LVEF ≤40% group and with that of TVR in LVEF >40% group. Prognostic impact of post-PCI FFR for the primary outcome was significantly different according to LVEF (Pinteraction = 0.019).

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%.

Original languageEnglish
Pages (from-to)229-240
Number of pages12
JournalJACC: Asia
Volume4
Issue number3
Early online date12 Dec 2023
DOIs
Publication statusPublished - Mar 2024
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2024 The Authors

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