Relative Fractional Flow Reserve Increase and Final Fractional Flow Reserve After Percutaneous Coronary Intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Physiology

Background:

• Fractional flow reserve (FFR) and its relative increase post-percutaneous coronary intervention (PCI) depend on baseline disease, PCI success, and residual burden.
• The prognostic value of relative FFR increase after PCI is not fully understood.

Purpose of the Study:

• To assess the prognostic significance of relative FFR increase alongside post-PCI FFR in patients undergoing PCI.
• To determine if relative FFR increase adds prognostic value to post-PCI FFR.

Main Methods:

• Analysis of 1,497 patients from the International Post PCI FFR Extended Registry with pre-PCI FFR ≤0.80.
• Calculation of percentage FFR increase (ΔFFR%) as ([post-PCI FFR - pre-PCI FFR]/pre-PCI FFR × 100).
• Primary endpoint: 5-year target vessel failure (TVF), including cardiac death, target vessel MI, or target vessel revascularization (TVR).

Main Results:

• Cutoffs of 15.0% for ΔFFR% and 0.80 for post-PCI FFR identified increased TVF risk.
• Failure to meet either cutoff was linked to higher TVF risk (ΔFFR%: adjusted HR 1.72; post-PCI FFR: adjusted HR 2.08).
• Post-PCI FFR ≤0.80 increased TVF regardless of ΔFFR%, with different drivers (non-TLR TVR vs. TLR) based on ΔFFR% sufficiency.

Conclusions:

• Relative FFR increase post-PCI has prognostic implications comparable to post-PCI FFR.
• Insufficient relative FFR increase with post-PCI FFR ≤0.80 indicates higher risk for in-stent restenosis.
• Sufficient relative FFR increase with post-PCI FFR ≤0.80 suggests risk from non-stented segment disease progression.