Diagnostics (Aug 2023)

Fractional Flow Reserve-Guided Stent Optimisation in Focal and Diffuse Coronary Artery Disease

  • Hirofumi Ohashi,
  • Damien Collison,
  • Takuya Mizukami,
  • Matthaios Didagelos,
  • Koshiro Sakai,
  • Muhammad Aetesam-ur-Rahman,
  • Daniel Munhoz,
  • Peter McCartney,
  • Thomas J. Ford,
  • Mitchell Lindsay,
  • Aadil Shaukat,
  • Paul Rocchiccioli,
  • Richard Brogan,
  • Stuart Watkins,
  • Margaret McEntegart,
  • Richard Good,
  • Keith Robertson,
  • Patrick O’Boyle,
  • Andrew Davie,
  • Adnan Khan,
  • Stuart Hood,
  • Hany Eteiba,
  • Tetsuya Amano,
  • Jeroen Sonck,
  • Colin Berry,
  • Bernard De Bruyne,
  • Keith G. Oldroyd,
  • Carlos Collet

DOI
https://doi.org/10.3390/diagnostics13152612
Journal volume & issue
Vol. 13, no. 15
p. 2612

Abstract

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Assessing coronary physiology after stent implantation facilitates the optimisation of percutaneous coronary intervention (PCI). Coronary artery disease (CAD) patterns can be characterised by the pullback pressure gradient (PPG) index. The impact of focal vs. diffuse disease on physiology-guided incremental optimisation strategy (PIOS) is unknown. This is a sub-study of the TARGET-FFR randomized clinical trial (NCT03259815). The study protocol directed that optimisation be attempted for patients in the PIOS arm when post-PCI FFR was n = 61 PIOS and 53 controls) with both pre-PCI fractional flow reserve (FFR) pullbacks and post-PCI FFR were included. A PPG ≥ 0.74 defined focal CAD. The PPG correlated significantly with post-PCI FFR (r = 0.43; 95% CI 0.26 to 0.57; p-value p-value p-value = 0.006). In patients randomized to PIOS, those with focal disease achieved higher post-PCI FFR than patients with diffuse CAD (0.93 ± 0.05 vs. 0.83 ± 0.07, p p-value for interaction = 0.004). Physiology-guided stent optimisation was applied more frequently to vessels with diffuse disease; however, patients with focal CAD at baseline achieved higher post-PCI FFR.

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