Baseline fractional flow reserve and stent diameter predict optimal post-stent fractional flow reserve and major adverse cardiac events after bare-metal stent deployment.
OBJECTIVE
We sought to identify baseline clinical, angiographic, and hemodynamic variables associated with optimal bare-metal stent (BMS) deployment, allowing selection of patients for treatment with BMS.


BACKGROUND
Patients with fractional flow reserve (FFR) >0.90 after BMS have low (<6%) major adverse cardiac event rates (MACE). We hypothesized that baseline variables can predict post-stent FFR >0.90 and MACE after BMS.


METHODS
In 586 patients from the multicenter post-BMS FFR registry, we developed multivariable logistic regression models to identify clinical, angiographic, and hemodynamic variables associated with post-stent FFR >or=0.90 and 6-month MACE.


RESULTS
After adjusting for potential confounders, baseline FFR (odds ratio [OR]: 5.0) and stent diameter (OR: 2.5 per millimeter) were predictive of post-stent FFR >0.90. Lower FFR (OR: 7.8); smaller stent diameter (OR: 3.7 per millimeter); longer stent length (OR: 1.0 per millimeter); and larger minimal luminal diameter (OR: 2.2 per millimeter) were predictors of MACE. In patients receiving 3-mm diameter stents, baseline FFR >0.70 yielded significantly higher likelihood of achieving post-stent FFR >0.90 than baseline FFR <or=0.70 (77% vs. 63%, p < 0.05); and in patients receiving <3-mm diameter stents, baseline FFR <0.50 was associated with higher MACE than FFR 0.50 to 0.70, and FFR >0.70 (40% vs. 15% vs. 13%, p < 0.05).


CONCLUSIONS
In patients receiving BMS, baseline FFR and stent diameter are predictors of post-stent FFR >0.90; and baseline FFR, stent diameter, stent length, and minimal luminal diameter are predictors of MACE. These variables may allow selection of patients who will have excellent results with BMS.
Samady
Habib
H
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. hsamady@emory.edu
McDaniel
Michael
M
Veledar
Emir
E
De Bruyne
Bernard
B
Pijls
Nico H
NH
Fearon
William F
WF
Vaccarino
Viola
V
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D001208:Asia; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005060:Europe; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
D008670:Metals