Impact of Post-PCI FFR Stratified by Coronary Artery

Carlos Collet; Nils P Johnson; Takuya Mizukami; William F Fearon; Colin Berry; Jeroen Sonck; Damien Collison; Bon-Kwon Koo; Nicolas Meneveau; Shiv Kumar Agarwal; Barry Uretsky; Abdul Hakeem; Joon-Hyung Doh; Bruno R Da Costa; Keith G Oldroyd; Jonathon A Leipsic; Umberto Morbiducci; Charles Taylor; Brian Ko; Pim A L Tonino; Divaka Perera; Toshiro Shinke; Claudio Chiastra; Andrei C Sposito; Antonio Maria Leone; Olivier Muller; Stephane Fournier; Hitoshi Matsuo; Julien Adjedj; Nicolas Amabile; Zsolt Piróth; Fernando Alfonso; Fernando Rivero; Jung-Min Ahn; Gabor G Toth; Abdul Ihdayhid; Nick E J West; Tetsuya Amano; Eric Wyffels; Daniel Munhoz; Marta Belmonte; Hirofumi Ohashi; Koshiro Sakai; Emanuele Gallinoro; Emanuele Barbato; Thomas Engstrøm; Javier Escaned; Ziad A Ali; Morton J Kern; Nico H J Pijls; Peter Jüni; Bernard De Bruyne

doi:10.1016/j.jcin.2023.08.018

Impact of Post-PCI FFR Stratified by Coronary Artery

Carlos Collet, Nils P Johnson, Takuya Mizukami, William F Fearon, Colin Berry, Jeroen Sonck, Damien Collison, Bon-Kwon Koo, Nicolas Meneveau, Shiv Kumar Agarwal, Barry Uretsky, Abdul Hakeem, Joon-Hyung Doh, Bruno R Da Costa, Keith G Oldroyd, Jonathon A Leipsic, Umberto Morbiducci, Charles Taylor, Brian Ko, Pim A L ToninoDivaka Perera, Toshiro Shinke, Claudio Chiastra, Andrei C Sposito, Antonio Maria Leone, Olivier Muller, Stephane Fournier, Hitoshi Matsuo, Julien Adjedj, Nicolas Amabile, Zsolt Piróth, Fernando Alfonso, Fernando Rivero, Jung-Min Ahn, Gabor G Toth, Abdul Ihdayhid, Nick E J West, Tetsuya Amano, Eric Wyffels, Daniel Munhoz, Marta Belmonte, Hirofumi Ohashi, Koshiro Sakai, Emanuele Gallinoro, Emanuele Barbato, Thomas Engstrøm, Javier Escaned, Ziad A Ali, Morton J Kern, Nico H J Pijls, Peter Jüni, Bernard De Bruyne^*

^*Corresponding author af dette arbejde

Afdeling for Hjertesygdomme

17 Citationer (Scopus)

Abstract

BACKGROUND: Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated.

OBJECTIVES: This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery.

METHODS: We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization.

RESULTS: Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005).

CONCLUSIONS: The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.

Originalsprog	Engelsk
Tidsskrift	JACC. Cardiovascular interventions
Vol/bind	16
Udgave nummer	19
Sider (fra-til)	2396-2408
Antal sider	13
ISSN	1936-8798
DOI	https://doi.org/10.1016/j.jcin.2023.08.018
Status	Udgivet - 9 okt. 2023

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10.1016/j.jcin.2023.08.018

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Collet, C., Johnson, N. P., Mizukami, T., Fearon, W. F., Berry, C., Sonck, J., Collison, D., Koo, B.-K., Meneveau, N., Agarwal, S. K., Uretsky, B., Hakeem, A., Doh, J.-H., Da Costa, B. R., Oldroyd, K. G., Leipsic, J. A., Morbiducci, U., Taylor, C., Ko, B., ... De Bruyne, B. (2023). Impact of Post-PCI FFR Stratified by Coronary Artery. JACC. Cardiovascular interventions, 16(19), 2396-2408. https://doi.org/10.1016/j.jcin.2023.08.018

Collet, C, Johnson, NP, Mizukami, T, Fearon, WF, Berry, C, Sonck, J, Collison, D, Koo, B-K, Meneveau, N, Agarwal, SK, Uretsky, B, Hakeem, A, Doh, J-H, Da Costa, BR, Oldroyd, KG, Leipsic, JA, Morbiducci, U, Taylor, C, Ko, B, Tonino, PAL, Perera, D, Shinke, T, Chiastra, C, Sposito, AC, Leone, AM, Muller, O, Fournier, S, Matsuo, H, Adjedj, J, Amabile, N, Piróth, Z, Alfonso, F, Rivero, F, Ahn, J-M, Toth, GG, Ihdayhid, A, West, NEJ, Amano, T, Wyffels, E, Munhoz, D, Belmonte, M, Ohashi, H, Sakai, K, Gallinoro, E, Barbato, E, Engstrøm, T, Escaned, J, Ali, ZA, Kern, MJ, Pijls, NHJ, Jüni, P & De Bruyne, B 2023, 'Impact of Post-PCI FFR Stratified by Coronary Artery', JACC. Cardiovascular interventions, bind 16, nr. 19, s. 2396-2408. https://doi.org/10.1016/j.jcin.2023.08.018

@article{a7307961829d402294d13a4237cee778,

title = "Impact of Post-PCI FFR Stratified by Coronary Artery",

abstract = "BACKGROUND: Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated.OBJECTIVES: This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery.METHODS: We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization.RESULTS: Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005).CONCLUSIONS: The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.",

keywords = "coronary artery disease, diffuse disease, percutaneous coronary intervention, post-PCI fractional flow reserve",

author = "Carlos Collet and Johnson, {Nils P} and Takuya Mizukami and Fearon, {William F} and Colin Berry and Jeroen Sonck and Damien Collison and Bon-Kwon Koo and Nicolas Meneveau and Agarwal, {Shiv Kumar} and Barry Uretsky and Abdul Hakeem and Joon-Hyung Doh and {Da Costa}, {Bruno R} and Oldroyd, {Keith G} and Leipsic, {Jonathon A} and Umberto Morbiducci and Charles Taylor and Brian Ko and Tonino, {Pim A L} and Divaka Perera and Toshiro Shinke and Claudio Chiastra and Sposito, {Andrei C} and Leone, {Antonio Maria} and Olivier Muller and Stephane Fournier and Hitoshi Matsuo and Julien Adjedj and Nicolas Amabile and Zsolt Pir{\'o}th and Fernando Alfonso and Fernando Rivero and Jung-Min Ahn and Toth, {Gabor G} and Abdul Ihdayhid and West, {Nick E J} and Tetsuya Amano and Eric Wyffels and Daniel Munhoz and Marta Belmonte and Hirofumi Ohashi and Koshiro Sakai and Emanuele Gallinoro and Emanuele Barbato and Thomas Engstr{\o}m and Javier Escaned and Ali, {Ziad A} and Kern, {Morton J} and Pijls, {Nico H J} and Peter J{\"u}ni and {De Bruyne}, Bernard",

year = "2023",

month = oct,

day = "9",

doi = "10.1016/j.jcin.2023.08.018",

language = "English",

volume = "16",

pages = "2396--2408",

journal = "JACC. Cardiovascular interventions",

issn = "1936-8798",

publisher = "Elsevier Inc",

number = "19",

}

TY - JOUR

T1 - Impact of Post-PCI FFR Stratified by Coronary Artery

AU - Collet, Carlos

AU - Johnson, Nils P

AU - Mizukami, Takuya

AU - Fearon, William F

AU - Berry, Colin

AU - Sonck, Jeroen

AU - Collison, Damien

AU - Koo, Bon-Kwon

AU - Meneveau, Nicolas

AU - Agarwal, Shiv Kumar

AU - Uretsky, Barry

AU - Hakeem, Abdul

AU - Doh, Joon-Hyung

AU - Da Costa, Bruno R

AU - Oldroyd, Keith G

AU - Leipsic, Jonathon A

AU - Morbiducci, Umberto

AU - Taylor, Charles

AU - Ko, Brian

AU - Tonino, Pim A L

AU - Perera, Divaka

AU - Shinke, Toshiro

AU - Chiastra, Claudio

AU - Sposito, Andrei C

AU - Leone, Antonio Maria

AU - Muller, Olivier

AU - Fournier, Stephane

AU - Matsuo, Hitoshi

AU - Adjedj, Julien

AU - Amabile, Nicolas

AU - Piróth, Zsolt

AU - Alfonso, Fernando

AU - Rivero, Fernando

AU - Ahn, Jung-Min

AU - Toth, Gabor G

AU - Ihdayhid, Abdul

AU - West, Nick E J

AU - Amano, Tetsuya

AU - Wyffels, Eric

AU - Munhoz, Daniel

AU - Belmonte, Marta

AU - Ohashi, Hirofumi

AU - Sakai, Koshiro

AU - Gallinoro, Emanuele

AU - Barbato, Emanuele

AU - Engstrøm, Thomas

AU - Escaned, Javier

AU - Ali, Ziad A

AU - Kern, Morton J

AU - Pijls, Nico H J

AU - Jüni, Peter

AU - De Bruyne, Bernard

PY - 2023/10/9

Y1 - 2023/10/9

N2 - BACKGROUND: Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated.OBJECTIVES: This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery.METHODS: We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization.RESULTS: Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005).CONCLUSIONS: The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.

AB - BACKGROUND: Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated.OBJECTIVES: This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery.METHODS: We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization.RESULTS: Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005).CONCLUSIONS: The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.

KW - coronary artery disease

KW - diffuse disease

KW - percutaneous coronary intervention

KW - post-PCI fractional flow reserve

UR - http://www.scopus.com/inward/record.url?scp=85172176696&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2023.08.018

DO - 10.1016/j.jcin.2023.08.018

M3 - Review

C2 - 37821185

SN - 1936-8798

VL - 16

SP - 2396

EP - 2408

JO - JACC. Cardiovascular interventions

JF - JACC. Cardiovascular interventions

IS - 19

ER -

Impact of Post-PCI FFR Stratified by Coronary Artery

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