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Trans-Stent FFR Gradient as a Modifiable Integrant in Predicting Long-Term Target Vessel Failure
Barry F Uretsky1, Shiv Kumar Agarwal1, Srikanth Vallurupalli1
1Central Arkansas VA Health System, Little Rock, Arkansas, USA; University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
JACC. Cardiovascular Interventions
|November 10, 2022
Summary
Trans-stent gradient (TSG) after percutaneous coronary intervention (PCI) predicts adverse events, especially target vessel failure (TVF). High TSG identifies patients at higher risk for poor outcomes post-PCI.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Fractional flow reserve (FFR) post-percutaneous coronary intervention (PCI) impacts long-term outcomes.
- Limited data exist on the association between FFR-based trans-stent gradient (TSG) post-PCI and long-term results.
Purpose of the Study:
- To evaluate the association between trans-stent gradient (TSG) after PCI and adverse cardiac events during follow-up.
- To determine if TSG can identify patients at higher risk for poor outcomes after PCI.
Main Methods:
- Prospective registry of 501 vessels in 416 patients with a median follow-up of 596 days.
- Primary endpoints included target vessel failure (TVF) and major adverse cardiac events (MACE).
- Analysis of TSG and post-PCI FFR values to assess their predictive capabilities.
Main Results:
- A median post-PCI FFR of 0.86 and median TSG of 0.04 were observed.
- TSG >0.04 was linked to increased rates of TVF and MACE.
- A subgroup with high TSG and low FFR exhibited significantly higher rates of TVF and MACE compared to other groups.
- Multivariate analysis confirmed TSG as an independent predictor of TVF.
Conclusions:
- Elevated TSG is an independent predictor of adverse events, particularly TVF, after PCI.
- The combination of high TSG and low FFR identifies patients with significantly worse outcomes.
- Incorporating TSG into FFR evaluation can help determine the functional success of PCI and guide patient management.
