title: Usefulness of coronary pressure measurement for functional evaluation of drug-eluting stent restenosis.
abstract: Despite the widespread adoption of drug-eluting stent (DES) implantation, the optimal treatment of DES failures remains challenging. The present study evaluated the relation between quantitative angiography and the fractional flow reserve (FFR) in restenotic lesions after DES implantation and the efficacy of FFR in determining whether to treat these lesions. To assess their functional significance, the coronary pressure-derived FFR was measured in 50 DES restenotic lesions (49 patients). Additional intervention was performed in lesions with a FFR <0.8. Major adverse cardiac events were assessed at 12 months after the reintervention procedure. The mean percent diameter stenosis (%DS) was 58 ± 13%. Of the 50 lesions, 20 (40%) were deferred without additional intervention. The FFR and %DS had a negative correlation (r = -0.61, p <0.001). However, when only the lesions with diffuse-type restenosis (15 lesions) were analyzed, the degree of correlation decreased (r = -0.56, p = 0.12). Although most lesions (89%) with a %DS of ≥70 had significant functional ischemia, among 41 lesions with a %DS <70, only 20 (49%) had demonstrated functional patency. The incidence of adverse events during the 12 months of follow-up after FFR-guided treatment was 18.0% (23.3% in the FFR <0.80 group and 10.0% in FFR ≥0.80 group). In conclusion, a discrepancy was found between functional ischemia measured by the FFR and the angiographic %DS, in particular, in moderate- or diffuse-type restenotic lesions after DES implantation. The outcome of FFR-guided deferral in patients with DES in-stent restenosis seems favorable.
authors.affiliation: Keimyung University Dongsan Medical Center, Daegu, Korea.
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.forename: Joon-Hyung
authors.initials: JH
authors.lastname: Doh
authors.forename: Woo-Young
authors.initials: WY
authors.lastname: Chung
authors.forename: Myeong-Ho
authors.initials: MH
authors.lastname: Yoon
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
authors.forename: Bong-Ki
authors.initials: BK
authors.lastname: Lee
authors.forename: Jin-Bae
authors.initials: JB
authors.lastname: Lee
authors.forename: Ki-Dong
authors.initials: KD
authors.lastname: Yoo
authors.forename: Yun-Kyeong
authors.initials: YK
authors.lastname: Cho
authors.forename: In-Sung
authors.initials: IS
authors.lastname: Chung
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Kwon-Bae
authors.initials: KB
authors.lastname: Kim
authors.forename: Cheol Ung
authors.initials: CU
authors.lastname: Choi
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Oh
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D054855:Drug-Eluting Stents; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged