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Long-Term and Temporal Relationships Between Post-Stent Fractional Flow Reserve and Clinical Outcomes.
Doyeon Hwang1, Jaewook Chung1, Seokhun Yang1
1Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
JACC. Cardiovascular Interventions
|December 10, 2025
Summary
Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) predicts long-term target vessel failure, especially within 3 years. However, its impact on nonstented segment TVR persists throughout 5 years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Physiology
Background:
- Fractional flow reserve (FFR) assesses flow limitation from residual disease post-percutaneous coronary intervention (PCI).
- Understanding the long-term prognostic value of post-PCI FFR is crucial for patient management.
Purpose of the Study:
- To evaluate the 5-year prognostic impact of post-PCI FFR on clinical outcomes.
- To analyze the temporal trends of FFR's predictive value over time.
Main Methods:
- Analysis of 2,128 patients with successful drug-eluting stent implantation and post-PCI FFR measurement.
- Primary outcome: target vessel failure (TVF), including cardiac death, target vessel MI, and target vessel revascularization (TVR).
- 5-year follow-up to assess clinical events.
Main Results:
- Higher risk of TVF at 5 years in the low post-PCI FFR group (aHR: 1.95).
- The increased risk for TVF was most prominent within 3 years post-PCI (aHR: 2.00) and attenuated thereafter (aHR: 1.80).
- TVR in nonstented segments showed a sustained higher risk in the low FFR group both within (aHR: 2.78) and beyond (aHR: 6.73) 3 years post-PCI.
Conclusions:
- Post-PCI FFR significantly impacts 5-year TVF, with a stronger effect in the initial 3 years.
- The prognostic significance of post-PCI FFR on TVR in nonstented segments extends throughout the 5-year follow-up.
- Findings from the International Post-PCI FFR Extended Registry (NCT05672862).
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