Author + information
- Received June 20, 2018
- Revision received July 23, 2018
- Accepted July 24, 2018
- Published online October 15, 2018.
- Joo Myung Lee, MD, MPH, PhDa,∗∗,
- Doyeon Hwang, MDb,
- Ki Hong Choi, MDa,
- Tae-Min Rhee, MDb,
- Jonghanne Park, MD, PhDb,
- Hyung Yoon Kim, MDc,
- Hae Won Jung, MDd,
- Ji-Won Hwang, MD, PhDe,
- Hyun-Jong Lee, MD, PhDf,
- Ho-Jun Jang, MDf,
- Su Hong Kim, MD, PhDg,
- Young Bin Song, MD, PhDa,
- Yun-Kyeong Cho, MD, PhDh,
- Chang-Wook Nam, MD, PhDh,
- Joo-Yong Hahn, MD, PhDa,
- Eun-Seok Shin, MD, PhDi,j,
- Yoshiaki Kawase, MDk,
- Akiko Matsuo, MDl,
- Nobuhiro Tanaka, MD, PhDm,
- Joon-Hyung Doh, MD, PhDe (, )
- Bon-Kwon Koo, MD, PhDb,n,∗ ( and )
- Hitoshi Matsuo, MD, PhDk
- aDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- bDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- cDepartment of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
- dDepartment of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea
- eDepartment of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
- fDepartment of Internal Medicine, Sejong General Hospital, Bucheon, Korea
- gDepartment of Cardiology, Busan Veterans Hospital, Busan, Korea
- hDepartment of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
- iDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- jDivision of Cardiology, Ulsan Hospital, Ulsan, Korea
- kDepartment of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
- lDepartment of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoko, Japan
- mDepartment of Cardiology, Tokyo Medical University, Tokyo, Japan
- nInstitute on Aging, Seoul National University, Seoul, Korea
- ↵∗Address for correspondence:
Dr. Bon-Kwon Koo, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul 03080, Korea.
- ↵∗∗Dr. Joon Hyung Doh, Department of Cardiology, Inje University Ilsan Paik Hospital, Juwha-ro 170 (Daewhadong), Ilsanseo-gu, Goyang-si, Gyeonggi-do 03080, Republic of Korea.
Objectives The study sought to investigate the prognostic implications of relative increase of fractional flow reserve (FFR) with PCI in combination with post–percutaneous coronary intervention (PCI) FFR.
Background FFR, measured after PCI has been shown to possess prognostic implications. The relative increase of FFR with PCI can be determined by the interaction of baseline disease pattern, adequacy of PCI, and residual disease burden in a target vessel. However, the role of relative increase of FFR with PCI has not yet been evaluated.
Methods A total of 621 patients who underwent PCI using second-generation drug-eluting stents based on low pre-PCI FFR (≤0.80) and available post-PCI FFR were analyzed. The relative increase of FFR was calculated by %FFR increase with PCI ([post-PCI FFR – pre-PCI FFR]/pre-PCI FFR × 100). Patients were divided according to the optimal cutoff values of post-PCI FFR (<0.84) and %FFR increase (≤15%). The primary outcome was target vessel failure (TVF) (a composite of cardiac death, target vessel–related myocardial infarction, and clinically driven target vessel revascularization) at 2 years.
Results Among the total population, 66.0% showed high post-PCI FFR (≥0.84) and 69.2% showed high %FFR increase (>15%). Patients with low post-PCI FFR showed a higher risk of 2-year TVF than did those with high post-PCI FFR (9.1% vs. 2.6%; hazard ratio [HR]: 3.367; 95% confidence interval [CI]: 1.412 to 8.025; p = 0.006). Patients with low %FFR increase also showed a higher risk of 2-year TVF compared with those with high %FFR increase (9.2% vs. 3.0%; HR: 3.613; 95% CI: 1.543 to 8.458; p = 0.003). Among the high post-PCI FFR group, there were no significant differences in clinical outcomes according to %FFR increase. Conversely, among the low post-PCI FFR group, those with low %FFR increase showed a significantly higher risk of TVF than did those with high %FFR increase (14.3% vs. 4.1%; HR: 4.334; 95% CI: 1.205 to 15.594; p = 0.025). Percent FFR increase significantly increased discriminant and reclassification ability for the occurrence of TVF when added to a model with clinical risk factors and post-PCI FFR (C-index 0.783 vs. 0.734; relative integrated discrimination improvement 0.702; p = 0.009; category-free net reclassification index 0.479; p = 0.031).
Conclusions Percent FFR increase with PCI showed similar prognostic implications with post-PCI FFR. Adding the relative increase of FFR to post-PCI FFR would enable better discrimination of high-risk patients after stent implantation. (Influence of FFR on the Clinical Outcome After Percutaneous Coronary Intervention [PERSPECTIVE]; NCT01873560)
This work was supported by a research grant from the Korean Circulation Society (No 201002-01) and by an unrestricted research grant from Philips Volcano. The company had no role in study design, conduct, data analysis, or manuscript preparation. Dr. Lee has received research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Hahn has received research grant support from St. Jude Medical (Abbott Vascular) and Boston Scientific. Dr. Doh has received institutional research grant support from Philips Volcano. Dr. Koo has received institutional research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 20, 2018.
- Revision received July 23, 2018.
- Accepted July 24, 2018.
- 2018 American College of Cardiology Foundation
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