The prognostic value of angiography-based vessel fractional flow reserve after percutaneous coronary intervention: The FAST Outcome study

Tara Neleman, Alessandra Scoccia, Kaneshka Masdjedi, Mariusz Tomaniak, Jurgen M.R. Ligthart, Karen T. Witberg, Alise Vermaire, Quinten Wolff, Leon Visser, Paul Cummins, Isabella Kardys, Jeroen Wilschut, Roberto Diletti, Wijnand K. Den Dekker, Felix Zijlstra, Nicolas M. Van Mieghem, Joost Daemen*

*Corresponding author for this work

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Abstract

Background: Vessel Fractional Flow Reserve (vFFR) as assessed by three-dimensional quantitative coronary angiography has high correlation with pressure wire-based fractional flow reserve in both a pre- and post-PCI setting. The present study aims to assess the prognostic value of post-PCI vFFR on the incidence of target vessel failure (TVF), a composite endpoint of cardiac death, target vessel myocardial infarction and target vessel revascularization (TVR) at 5-year follow up. Methods: Post-PCI vFFR was calculated after routine PCI in a total of 748 patients (832 vessels) with available orthogonal angiographic projections of the stented segment. Results: Median age was 65 (IQR 55–74) years, 18.2% were diabetic, and 29.1% presented with stable angina. Median post-PCI vFFR was 0.91 (IQR 0.86–0.95). Vessels were categorized into tertiles based on post-PCI vFFR: low (vFFR <0.88), middle (vFFR 0.88–0.93), and upper (vFFR ≥0.94). Vessels in the lower and middle tertile were more often LADs and had smaller stent diameters (p<0.001). Vessels in the lower and middle tertile had a higher risk of TVF as compared to vessels in the upper tertile (24.6% and 21.5% vs. 17.1%; adjusted HR 1.84 (95%CI 1.15–2.95), p = 0.011, and 1.58 (95%CI 1.02–2.45), p = 0.040) at 5-years follow-up. Additionally, vessels in the lower tertile had higher rates of TVR as compared to vessels in the higher tertile (12.6% vs. 6.5%, adjusted HR 1.93 (95%CI 1.06–3.53), p = 0.033). Conclusion: Lower post-PCI vFFR values are associated with a significantly increased risk of TVF and TVR at 5-years follow-up.

Original languageEnglish
Pages (from-to)14-19
Number of pages6
JournalInternational Journal of Cardiology
Volume359
Early online date11 Apr 2022
DOIs
Publication statusPublished - 15 Jul 2022

Bibliographical note

Funding Information:
Joost Daemen received institutional grant/research support from Astra Zeneca, Abbott Vascular, Boston Scientific, ACIST Medical, Medtronic, Pie Medical, and ReCor medical. Nicolas Van Mieghem has received institutional research grant support from Abbott Vascular, Boston Scientific, Edwards Lifesciences, Medtronic, Daiichi-Sankyo, PulseCath BV, and Abiomed. Tara Neleman received institutional grant support from Acist Medical Systems. Mariusz Tomaniak acknowledges funding as the laureate of the European Society of Cardiology Research and Training Program in the form of the ESC 2018 Grant (T-2018-19,628). Roberto Diletti reports institutional research grant to the Erasmus University Medical Center, consultant to ACIST Medical Systems. The remaining authors have nothing to disclose.

Funding Information:
Joost Daemen received institutional grant/research support from Astra Zeneca, Abbott Vascular , Boston Scientific , ACIST Medical, Medtronic, Pie Medical, and ReCor medical. Nicolas Van Mieghem has received institutional research grant support from Abbott Vascular , Boston Scientific , Edwards Lifesciences , Medtronic, Daiichi-Sankyo, PulseCath BV, and Abiomed. Tara Neleman received institutional grant support from Acist Medical Systems. Mariusz Tomaniak acknowledges funding as the laureate of the European Society of Cardiology Research and Training Program in the form of the ESC 2018 Grant (T-2018-19,628). Roberto Diletti reports institutional research grant to the Erasmus University Medical Center, consultant to ACIST Medical Systems. The remaining authors have nothing to disclose.

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