Impact of lesion characteristics on the prediction of optimal poststent fractional flow reserve

• Published in: The American heart journal 2016-12, Vol.182, p.119-124
• Main Authors: Ando, Hirohiko, Takashima, Hiroaki, Suzuki, Akihiro, Sakurai, Shinichiro, Kumagai, Soichiro, Kurita, Akiyoshi, Waseda, Katsuhisa, Amano, Tetsuya
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Adenosine; Aged; Angina, Stable - diagnosis; Angina, Stable - therapy; Cardiovascular disease; Clinical outcomes; Coronary Angiography - methods; Coronary Restenosis - diagnosis; Coronary Restenosis - etiology; Coronary Restenosis - physiopathology; Coronary vessels; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Coronary Vessels - physiopathology; Drug-Eluting Stents - adverse effects; Female; Fractional Flow Reserve, Myocardial; Funding; Heart attacks; Humans; Japan; Male; Middle Aged; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - methods; Predictive Value of Tests; Prognosis; Retrospective Studies; Statistical analysis; Statistics as Topic; Stents; Variables
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2016.09.015

Poststent fractional flow reserve (FFR) is a useful indicator of optimal percutaneous coronary intervention, and higher poststent FFR is associated with favorable long-term clinical outcome. However, little is known about the factors influencing poststent FFR. The purpose of this study was to determine the impact of lesion characteristics on poststent FFR. For patients who had scheduled stent implantation for stable angina, FFR measurements at maximum hyperemia were performed before and after coronary stent implantation. As one of lesion characteristics, the FFR pressure drop pattern was evaluated and classified as either an abrupt or a gradual pattern according to the pullback curve of FFR. A total of 205 lesions with physiological significant stenosis were evaluated. Fractional flow reserve value increased from 0.67±0.10 to 0.87±0.07 after stent implantation. Optimal poststent FFR was achieved in 75 lesions (36.6%). Logistic regression analysis demonstrated that optimal poststent FFR was positively correlated with an abrupt pressure drop pattern (hazard ratio [HR] 2.11, 95% CI 1.06-4.15, P=.03) and prestent FFR (HR 1.04, 95% CI 1.03-2.04, P=.03; per 0.1 increase), and negatively correlated with lesion localization to the left anterior descending artery (HR 0.18, 95% CI 0.09-0.36, P