Baseline Fractional Flow Reserve and Stent Diameter Predict Optimal Post-Stent Fractional Flow Reserve and Major Adverse Cardiac Events After Bare-Metal Stent Deployment
Habib Samady, MD*,*,
Michael McDaniel, MD*,
Emir Veledar, PhD*,
Bernard De Bruyne, MD, PhD ,
Nico H. Pijls, MD, PhD ,
William F. Fearon, MD ,
Viola Vaccarino, MD, PhD*
* Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
Cardiovascular Center, Aalst, Belgium
Stanford University, Stanford, California
* Reprint requests and correspondence: Dr. Habib Samady, Associate Professor of Medicine, Emory University School of Medicine, Suite F606, 1365 Clifton Road, Atlanta, Georgia (Email: hsamady{at}emory.edu).
Objectives: We sought to identify baseline clinical, angiographic, and hemodynamic variables associated with optimal bare-metal stent (BMS) deployment, allowing selection of patients for treatment with BMS.
Background: Patients with fractional flow reserve (FFR) >0.90 after BMS have low (<6%) major adverse cardiac event rates (MACE). We hypothesized that baseline variables can predict post-stent FFR >0.90 and MACE after BMS.
Methods: In 586 patients from the multicenter post-BMS FFR registry, we developed multivariable logistic regression models to identify clinical, angiographic, and hemodynamic variables associated with post-stent FFR  0.90 and 6-month MACE.
Results: After adjusting for potential confounders, baseline FFR (odds ratio [OR]: 5.0) and stent diameter (OR: 2.5 per millimeter) were predictive of post-stent FFR >0.90. Lower FFR (OR: 7.8); smaller stent diameter (OR: 3.7 per millimeter); longer stent length (OR: 1.0 per millimeter); and larger minimal luminal diameter (OR: 2.2 per millimeter) were predictors of MACE. In patients receiving 3-mm diameter stents, baseline FFR >0.70 yielded significantly higher likelihood of achieving post-stent FFR >0.90 than baseline FFR  0.70 (77% vs. 63%, p < 0.05); and in patients receiving <3-mm diameter stents, baseline FFR <0.50 was associated with higher MACE than FFR 0.50 to 0.70, and FFR >0.70 (40% vs. 15% vs. 13%, p < 0.05).
Conclusions: In patients receiving BMS, baseline FFR and stent diameter are predictors of post-stent FFR >0.90; and baseline FFR, stent diameter, stent length, and minimal luminal diameter are predictors of MACE. These variables may allow selection of patients who will have excellent results with BMS.
Key Words: fractional flow reserve • bare-metal stents • percutaneous coronary interventions • moderate coronary lesion assessment
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Abbreviations and Acronyms
| | ATP = adenosine triphosphate | | BMS = bare-metal stent(s) | | DES = drug-eluting stent(s) | | FFR = fractional flow reserve | | MACE = major adverse cardiac event(s) | | MLD = minimal luminal diameter | | PCI = percutaneous coronary intervention |
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