Predictive value of residual vessel fractional flow reserve for optimizing coronary physiology postrevascularization

Vessel fractional flow reserve (vFFR) is an angiography-based assessment for coronary physiology. vFFR can be measured at baseline and after percutaneous coronary intervention (PCI). Residual vFFR, a feature designed to predict post-PCI vFFR following stent implantation, can be utilized for PCI planning. This study aimed to investigate the correlation between residual vFFR and post-PCI vFFR, and to identify factors associated with achieving post-PCI vFFR greater than or equal to 0.90.

Between July 2017 to December 2022, 143 chronic coronary syndrome patients (222 vessels) undergoing image-guided PCI using second-generation drug-eluting stents were analyzed retrospectively. Pre-PCI vFFR, residual vFFR, and post-PCI vFFR were calculated using coronary angiograms obtained before and after PCI.

Residual vFFR showed a moderate correlation with post-PCI vFFR ( r  = 0.65, P  < 0.001) and had a good predictive value for post-PCI vFFR greater than or equal to 0.90 (area under the curve: 0.83, 95% confidence interval: 0.76-0.90). Multivariable logistic regression analysis indicated non-left anterior descending (LAD) lesions (odds ratio: 4.30, 95% confidence interval: 1.76-10.49; P  = 0.001) and stent size greater than or equal to 3.0 mm (odds ratio: 4.23, 95% confidence interval: 1.83-9.74; P  < 0.001) were associated with optimal post-PCI vFFR.

Residual vFFR demonstrated a strong predictive value for achieving post-PCI vFFR greater than or equal to 0.90. Non-LAD lesions and stent sizes greater than or equal to 3 mm were associated with achieving optimal physiological outcomes after PCI.