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Coronary pressure and FFR predict long-term outcome after PTCA
G Jan-Willem Bech1, Bernard De Bruyne, T Akasaka
1Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Summary
Fractional flow reserve (FFR) measurement can identify patients who benefit from coronary artery stenting after percutaneous transluminal coronary angioplasty (PTCA). High FFR values indicate a lower risk of restenosis, potentially avoiding unnecessary stenting and associated long-term issues.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Devices
Background:
- Coronary stents are a key advancement in percutaneous coronary interventions (PCI).
- Many patients achieve favorable outcomes after percutaneous transluminal coronary angioplasty (PTCA) without stenting.
- Coronary angiography alone is insufficient to identify patients suitable for non-stenting approaches.
Purpose of the Study:
- To evaluate the utility of coronary pressure measurement for guiding stenting decisions after PTCA.
- To determine if fractional flow reserve (FFR) can predict restenosis risk in patients treated with balloon angioplasty alone.
- To assess the role of intravascular ultrasound (IVUS) in understanding the mechanism of favorable functional results.
Main Methods:
- Investigated 85 patients undergoing PTCA.
- Measured coronary pressure using fractional flow reserve (FFR) to assess functional significance.
- Utilized intravascular ultrasound (IVUS) to examine lumen size and angioplasty mechanisms.
- Compared outcomes between patients with high FFR (>0.90) and low FFR (<0.90).
Main Results:
- Patients with high FFR (>0.90) after PTCA had a nearly threefold lower incidence of coronary events at two-year follow-up.
- High FFR values were achievable in approximately 45% of patients treated with plain balloon angioplasty.
- IVUS studies indicated that a larger lumen post-angioplasty contributed to high FFR values.
- Optimal angiographic and functional results (high FFR) correlated with restenosis rates comparable to stenting.
Conclusions:
- Coronary angiography and pressure measurement (FFR) offer complementary value in evaluating PTCA outcomes.
- FFR assessment can guide decisions for conditional stenting, identifying patients who may not require stents.
- Using a pressure wire instead of a regular guidewire provides valuable functional information, potentially avoiding stenting and associated long-term complications.