Author + information
- Gabriel Tensol Rodrigues Pereira,
- Luis Augusto Palma Dallan,
- Patricia Pizzato,
- Armando Vergara-Martel,
- Elder Zago,
- Vlad Zimin,
- Dean Jia,
- Mehmet Elbey,
- Jawwad Abdul Samdani,
- Guilherme Attizzani and
- Hiram Bezerra
Fractional flow reserve (FFR) is a reliable and reproducible invasive method to assess coronary ischemia due to its physiologic approach. Some studies found that post stenting FFR above 0.90 predicts good outcomes, but thin assessment reflects a vessel level, providing limited information regarding the just-placed stent.
We investigated whether optimization of the stented segment as seen in optical coherence tomography (OCT) imaging would impact post-percutaneous coronary intervention (PCI) FFR values.
This is a sub-analysis of ILUMIEN I study, a large, prospective, observational, non-randomized study of PCI procedural practice in patients undergoing intraprocedural pre- and post-PCI FFR and OCT. The study population was already described in ILUMIEN I main study, but in summary, included patients presenting with stable coronary artery disease, unstable angina and non-ST-elevation myocardial infarction. FFR variation between the timepoints of >0.02 was considered significant.
From 418 patients with 421 lesions, we selected 59 patients who had both FFR and OCT data after stenting and post-stenting optimization. From the total, 31 patients (52.5%) did not present significant FFR variation (<0.02) after post-stenting optimization and 28 patients (47.5%) had significant variation (>0.02). Regarding OCT data, from the 31 patients without FFR variation, mean diameter stenosis variation was 0.12 (±0.96), mean area variation was 0.50 (±0.72) and an extend expansion varied 7.8 (±14.1). From the 28 patients group with FFR variation, mean diameter stenosis variation was 0.08 (±0.12), mean area variation was 0.39 (±0.58) and extent expansion varied 9.95 (±10.1), showing similar results between the two groups.
Our results revealed that significant changes in post-stented segment vessel as seen in OCT imaging had low impact in post-PCI FFR values, showing that there is no direct correlation between functional and morphological assessments. This demonstrates that FFR might have limited ability to detect important features of the stented segment that relates to patient outcome. Further studies are necessary to evaluate how vessel changes after post-stenting optimization would predict accurate functional determination.