title: Clinical and prognostic value of poststenting fractional flow reserve in acute coronary syndromes.
abstract: Fractional flow reserve (FFR) has been suggested to have value in acute coronary syndromes (ACSs). The clinical and prognostic value of ischaemia reduction assessed by post-percutaneous coronary intervention (PCI) FFR has not been studied in this population.
  
  
  
  Consecutive stable ischaemic heart disease (SIHD) (N=390) and patients with ACS (N=189) who had pre-PCI FFR and post-PCI FFR were followed for 2.4±1.5 years. Primary endpoint was major adverse cardiac events (MACE) (composite of myocardial infarction, target vessel revascularisation and death).
  
  
  
  In patients with ACS, PCI led to significant improvement in FFR from 0.62±0.15 to post-PCI FFR 0.88±0.08 (p<0.0001). Post-PCI FFR identified 29 patients (15%) who had persistently low FFR<0.80 (0.75±0.06) despite angiographically optimal results prompting subsequent interventions improving repeat FFR (0.85±0.06; p<0.0001). The difference in MACE events between patients with ACS and patients with SIHD varied according to the post-PCI FFR value (interaction p=0.044). Receiver operator curve analysis identified a final FFR cut-off of ≤0.91 as having the best predictive accuracy for MACE in the ACS study population (30% vs 19%; p=0.03). Patients with ACS achieving final FFR of >0.91 had similar outcomes compared with patients who had SIHD (19% vs 16%; p=0.51). However, in patients with final FFR of ≤0.91 there was increased MACE versus patients with SIHD (30% vs 16%; p<0.01).
  
  
  
  Post-PCI FFR is valuable in assessing the functional outcome of PCI in patients with ACS. Use of post-PCI FFR in patients with ACS allows for functional optimisation of PCI results and is predictive of long-term outcomes in patients with ACS.
authors: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors: Srikanth
authors: S
authors: Kasula
authors: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors: Shiv Kumar
authors: SK
authors: Agarwal
authors: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors: Yalcin
authors: Y
authors: Hacioglu
authors: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors: Nagavenkata Krishnachand
authors: NK
authors: Pothineni
authors: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors: Sabha
authors: S
authors: Bhatti
authors: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.|Cardiology Section, Central Arkansas Veterans Affair Health System, Little Rock, Arkansas, USA.
authors: Zubair
authors: Z
authors: Ahmed
authors: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.|Cardiology Section, Central Arkansas Veterans Affair Health System, Little Rock, Arkansas, USA.
authors: Barry
authors: B
authors: Uretsky
authors: Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.|Cardiology Section, Central Arkansas Veterans Affair Health System, Little Rock, Arkansas, USA.
authors: Abdul
authors: A
authors: Hakeem
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000789:Angina, Unstable / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019540:Area Under Curve; D001131:Arkansas; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011237:Predictive Value of Tests; D012372:ROC Curve; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome