title: Fractional flow reserve predicts major adverse cardiac events after coronary stent implantation.
abstract: OBJECTIVE
  Determination of fractional flow reserve (FFR) allows the functional assessment of coronary stenoses before and after an intervention. Preliminary data suggest that a FFR > or = 0.94 is associated with an excellent clinical outcome after stent implantation. However, these results were limited both by the number of patients included and the use of non-contemporary stent designs. We sought to determine the prognostic value of FFR measurements in a large patient cohort undergoing coronary stent implantation.
  
  
  METHODS
  Eighty-nine consecutive patients were enrolled in whom a stent implantation was performed and a pressure wire was used as a guide wire. Patients were followed for at least 6 months. Death, myocardial infarction (MI) and target vessel revascularization (TVR) were considered cardiac events. A FFR > or = 0.94 was regarded as an optimal functional result.
  
  
  RESULTS
  A complete follow-up was available in all patents. Pre-interventional FFR increased from 0.66 +/- 0.16 to 0.95 +/- 0.05 (p < 0.0001) after stent implantation. Sixteen (18%) events occurred during follow-up including 10 (11.2%) TVR. Final FFR was significantly higher in patients without compared to patients with an event (0.92 +/- 0.06 vs. 0.96 +/- 0.05, p < 0.003). By univariate analysis, the presence of diabetes mellitus, left ventricular function, residual diameter stenosis and final FFR were associated with a worse clinical outcome. In the multivariate analysis, only the final FFR and left ventricular function remained as significant predictors for cardiac events (relative risk, 3.50; 95% CI: 1.29-9.52, P < 0.014, and 0.97; 95% CI: 0.93-1.00, p = 0.047).
  
  
  CONCLUSIONS
  These results demonstrate in a nonselected patient cohort a strong correlation between FFR values after coronary stenting and subsequent cardiac events. Further studies have to investigate whether outcome after stenting might be improved by guiding the procedure with a pressure guide wire.
authors.affiliation: Dept. of Cardiology, Medizinische Klinik-Innenstadt, University of Munich, Ziemssenstr. 1 80336 Munich, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Rieber
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Schiele
authors.forename: Petra
authors.initials: P
authors.lastname: Erdin
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Stempfle
authors.forename: Andreas
authors.initials: A
authors.lastname: König
authors.forename: Isabelle
authors.initials: I
authors.lastname: Erhard
authors.forename: Tobias
authors.initials: T
authors.lastname: Segmiller
authors.forename: Monika
authors.initials: M
authors.lastname: Baylacher
authors.forename: Karl
authors.initials: K
authors.lastname: Theisen
authors.forename: Mathias C
authors.initials: MC
authors.lastname: Haufe
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: Volker
authors.initials: V
authors.lastname: Klauss
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D015331:Cohort Studies; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left