Author + information
- Received January 11, 2017
- Revision received February 14, 2017
- Accepted February 14, 2017
- Published online May 15, 2017.
- Sui-Ji Li, MDa,b,
- Zhen Ge, MDa,
- Jing Kan, MBBSa,
- Jun-Jie Zhang, PhDa,
- Fei Ye, MDa,
- Tak W. Kwan, MDc,
- Teguh Santoso, MDd,
- Song Yang, MDe,
- Imad Sheiban, MDf,
- Xue-Song Qian, MDg,
- Nai-Liang Tian, MDa,
- Tanveer S. Rab, MDh,
- Ling Tao, MDi and
- Shao-Liang Chen, MDa,∗ ()
- aDivision of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- bDivision of Cardiology, Jintan People’s Hospital, Jintan, China
- cDivision of Cardiology, Mount Sinai Beth Israel Hospital, New York, New York
- dDivision of Cardiology, Medistra Hospital, University of Indonesia, Jakarta, Indonesia
- eDivision of Cardiology, Yixin People’s Hospital, Yixin, China
- fDivision of Cardiology, Turin University Hospital, Turin, Italy
- gDivision of Cardiology, Zhangjiagang People’s Hospital, ZhangjiaGang, China
- hDivision of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- iDivision of Cardiology, Xijing Hospital, 4th Military Medical University, Xi’an, China
- ↵∗Address for correspondence:
Dr. Shao-Liang Chen, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Objectives This study aimed to investigate the cutoff of post–drug-eluting stent (DES) fractional flow reserve (FFR) for prediction of 1- to 3-year target vessel failure (TVF).
Background FFR immediately after a DES implantation correlates with clinical events. However, the cutoff of post-DES FFR for predicting long-term clinical events remains understudied.
Methods Between May 2012 and September 2013, a total of 1,476 patients who had FFR <0.8 at maximal and at baseline underwent DES implantation were prospectively studied in 9 centers. Post-DES FFR was repeat measured. The primary endpoint was the 1-year TVF rate after procedures. Receiver-operating characteristic curves were used to calculate the post-DES FFR value for TVF, then patients were classified on the basis of this value and followed up for 3 years.
Results By the end of the first year, 88 (6.0%) TVFs were recorded. A post-DES FFR ≤0.88 strongly correlated with TVF. Disease in the left anterior descending coronary artery (LAD), stent length, and stent diameter were independent factors of impaired post-DES FFR, whereas post-procedure FFR ≤0.88 was the only predictor of TVF, with 40 (4.0%) TVFs in the FFR >0.88 and 48 (8.0%) in the FFR ≤0.88 group (p = 0.001), mainly driven by target vessel revascularization (3.8% vs. 8.8%; p = 0.005) and cardiac death (0.2% vs. 1.3%; p = 0.017). The difference in TVF between 2 groups was maintained through 3-year follow-up (p = 0.002). For patients with LAD lesions, a post-DES FFR ≤0.905 predicted 1-year TVF.
Conclusions Post-DES FFR strongly correlated with TVF rate. Mechanisms attributed to and treatments for impaired FFR after stenting should be studied in future studies. (Post-DES FFR Predicts the Clinical Outcomes: DK CRUSH-VII, A Prospective, Multicenter, Registry Study [DK CRUSH-VII]; ChiCTR-PRCH-12001976)
- drug-eluting stent
- fractional flow reserve
- percutaneous coronary intervention
- target vessel failure
This study was funded by the National Natural Science Foundation of China (grants NSFC 81270191, NSFC 91439118, and NSFC 91936303). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Li and Ge contributed equally to this work.
- Received January 11, 2017.
- Revision received February 14, 2017.
- Accepted February 14, 2017.
- 2017 American College of Cardiology Foundation