title: Utilizing Post-Intervention Fractional Flow Reserve to Optimize Acute Results and the Relationship to Long-Term Outcomes.
abstract: This study sought to evaluate the impact of fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) on subsequent in-lab interventional management vessels that had undergone pre-PCI FFR and its prognostic value in predicting long-term (>1 year) outcomes.
  
  
  
  Post-PCI FFR has been shown to be a predictor of intermediate-term (6 months) adverse events. However, its impact on immediate post procedure clinical decision making and long-term outcomes is not known.
  
  
  
  Consecutive patients undergoing PCI who had pre- and post-PCI FFR evaluations were followed for major adverse cardiovascular events (MACE).
  
  
  
  In the study 574 patients (664 lesions) were followed for 31 ± 16 months. PCI led to significant improvement in FFR from 0.65 ± 0.14 to 0.87 ± 0.08 (p < 0.0001). Despite satisfactory angiographic appearance, 143 lesions (21%) demonstrated post-PCI FFR in the ischemic range (FFR ≤0.81). After subsequent interventions, FFR in this subgroup increased from 0.78 ± 0.08 to 0.87 ± 0.06 (p < 0.0001). Final FFR cutoff of ≤0.86 had the best predictive accuracy for MACE and ≤0.85 for TVR. Patients who achieved final FFR >0.86 had significantly lower MACE compared to the final FFR ≤0.86 group (17% vs. 23%; log-rank p = 0.02). Final FFR ≤0.86 had incremental prognostic value over clinical and angiographic variables for MACE prediction.
  
  
  
  Post-PCI FFR reclassified 20% of angiographically satisfactory lesions, which required further intervention thereby providing an opportunity for complete functional optimization at the time of the index procedure. This is particularly important as FFR post-PCI FFR was a powerful independent predictor of long-term outcomes.
authors.affiliation: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Shiv K
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Kasula
authors.affiliation: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Hacioglu
authors.affiliation: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Cardiology Section, Central Arkansas Veteran Affairs Health System, Little Rock, Arkansas.
authors.forename: Zubair
authors.initials: Z
authors.lastname: Ahmed
authors.affiliation: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Cardiology Section, Central Arkansas Veteran Affairs Health System, Little Rock, Arkansas.
authors.forename: Barry F
authors.initials: BF
authors.lastname: Uretsky
authors.affiliation: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Cardiology Section, Central Arkansas Veteran Affairs Health System, Little Rock, Arkansas. Electronic address: ahakeem@gmail.com.
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakeem
mesh_terms: D000368:Aged; D001131:Arkansas; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: fractional flow reserve; functional optimization; major adverse cardiovascular outcomes; percutaneous coronary intervention; prognosis