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Usefulness of the trans-stent fractional flow reserve gradient for predicting clinical outcomes

Session Intravascular imaging and physiology to optimise outcomes

Speaker Hong Seok Lim

Congress : ESC Congress 2019

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Invasive Imaging and Functional Assessment
  • Session type : Rapid Fire Abstracts
  • FP Number : 6112

Authors : H Lim (Suwon,KR), HM Yang (Suwon,KR), MH Yoon (Suwon,KR), KW Seo (Suwon,KR), BJ Choi (Suwon,KR), SY Choi (Suwon,KR), JY Seo (Suwon,KR), U Jin (Suwon,KR), SJ Tahk (Suwon,KR)

Authors:
H Lim1 , HM Yang1 , MH Yoon1 , KW Seo1 , BJ Choi1 , SY Choi1 , JY Seo1 , U Jin1 , SJ Tahk1 , 1Ajou University Medical Center - Suwon - Korea (Republic of) ,

Citation:

Aims: The clinical meaning of a trans-stent pressure gradient after DES implantation has not been estimated adequately. We evaluated the usefulness of a fractional flow reserve (FFR) gradient across the stent (?FFRstent) for long-term clinical outcomes after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES).
Methods and Results: FFR pull-back and intravascular ultrasound (IVUS) were performed after successful PCI in 135 left anterior descending artery lesions. ?FFRstent was defined as the FFR gradient across the stent. The ?FFRstent/length was defined as the ?FFRstent value divided by the total stent length multiplied by 10 [= (?FFRstent ÷ stent length) x 10]. Major adverse cardiac events (MACEs) were the composite of all-cause death, target vessel related myocardial infarction, and target lesion revascularisation. Despite successful PCI without significant complications on IVUS, ?FFRstent > 0 was observed in 98.5% of cases. ?FFRstent =0.04 and ?FFRstent/length = 0.009 predicted suboptimal stenting defined as final minimal stent area < 5.5 mm². During 2183 ± 898 days, the MACE-free survival rate was significantly lower in patients with ?FFRstent = 0.04 and ?FFRstent/length = 0.009 compared to those with lower values (69.6 vs. 93.4%, log-rank p = 0.031; 72.1 vs. 97.7%, log-rank p =0.003, respectively). ?FFRstent/length = 0.009 (hazard ratio 10.1, p = 0.032) was an independent predictor of MACE.
Conclusion: A trans-stent FFR gradient was frequently observed in DES-treated patients despite successful PCI results. ?FFRstent and ?FFRstent/length are useful indicators for optimising a DES and are related to long-term outcomes.

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