Clinical and physiological outcomes of fractional flow reserve-guided percutaneous coronary intervention in patients with serial stenoses within one coronary artery.
OBJECTIVE
This study was performed to evaluate the physiological and clinical outcomes of fractional flow reserve (FFR)-guided revascularization strategy with drug-eluting stents in serial stenoses within the same coronary artery.


BACKGROUND
Identifying a functionally significant stenosis is difficult when several stenoses exist within 1 coronary artery.


METHODS
A total of 131 patients (141 vessels and 298 lesions) with multiple intermediate stenoses within the same coronary artery were assessed by FFR with pullback pressure tracings. In vessels with an FFR <0.8, the stenosis that caused the largest pressure step-up was stented first. Major adverse cardiac events were assessed during follow-up.


RESULTS
FFR was measured 239 times and there were no procedure-related complications. There was a weak negative correlation between FFR and angiographic percent diameter stenosis (r = -0.282, p < 0.001). In total, 116 stents were implanted and revascularization was deferred in 61.1% (182 of 298) of lesions. When the vessels with an initial FFR <0.8 were divided into 2 groups according to FFR after first stenting (FFR ≥0.8 vs. FFR <0.8), there were no differences in baseline angiographic and physiological parameters between the 2 groups. During the mean follow-up of 501 ± 311 days, there was only 1 target vessel revascularization due to in-stent restenosis. There were no events related to deferred lesions.


CONCLUSIONS
FFR-guided revascularization strategy using pullback pressure tracing in serial stenoses was safe and effective. This strategy can reduce unnecessary intervention and maximize the benefit of percutaneous coronary intervention with drug-eluting stents in patients with multiple stenoses within 1 coronary artery.
Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Hack-Lyoung
HL
Kim
Bon-Kwon
BK
Koo
Chang-Wook
CW
Nam
Joon-Hyung
JH
Doh
Ji-Hyun
JH
Kim
Han-Mo
HM
Yang
Kyung-Woo
KW
Park
Hae-Young
HY
Lee
Hyun-Jae
HJ
Kang
Young-Seok
YS
Cho
Tae-Jin
TJ
Youn
Sang-Hyun
SH
Kim
In-Ho
IH
Chae
Dong-Ju
DJ
Choi
Hyo-Soo
HS
Kim
Byung-Hee
BH
Oh
Young-Bae
YB
Park
D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy; D023903:Coronary Restenosis / Q000517:prevention & control* / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D056910:Republic of Korea; D013223:Statistics as Topic; D016896:Treatment Outcome