title: Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention.
abstract: Fractional flow reserve (FFR) and coronary flow reserve (CFR) are well-validated physiological indices; however, changes in FFR and CFR after percutaneous coronary intervention (PCI) remain elusive. We sought to evaluate these changes and to investigate whether physiological indices predict cardiac event-free survival after PCI.
  
  
  
  Physiological assessment of 220 stenoses from 220 patients was performed before and after PCI. The changes in FFR and CFR were studied, and factors associated with CFR change were investigated. Follow-up data were collected to determine the predictor of cardiac events. CFR increase was found in 158 (71.8%) territories, and 62 (28.2%) presented a decrease, whereas FFR increased in all 220 (100%) territories. Pre- and post-PCI percentage diameter stenoses were 57.7±11.2% and 7.48±4.79%, respectively. Post-PCI CFR increase was associated with pre-PCI indices including low FFR, low CFR and high microvascular resistance, and post-PCI hyperemic coronary flow increase. Post-PCI CFR decrease was not associated with significant post-PCI hyperemic coronary flow increase. At a median follow-up of 24.3 months, adverse event-free survival was significantly worse in patients with lower pre-PCI CFR (log-rank test λ2=7.26; P=0.007). Cox proportional hazards analysis showed that lower pre-PCI CFR (hazard ratio 0.73; 95% CI 0.55-0.97; P=0.028) was an independent predictor of adverse cardiovascular events after PCI.
  
  
  
  CFR decrease after PCI was not uncommon, and discordant change in FFR and CFR was associated with high pre-PCI CFR, low pre-PCI microvascular resistance, and no significant post-PCI hyperemic coronary flow increase. Pre-PCI CFR, not post-PCI physiological indices, may help identify patients who require adjunctive management strategy after successful PCI.
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.|Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Matsuda
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Murai
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kanaji
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Usui
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Araki
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Niida
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Sadamitsu
authors.initials: S
authors.lastname: Ichijyo
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Rikuta
authors.initials: R
authors.lastname: Hamaya
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Tetsumin
authors.initials: T
authors.lastname: Lee
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
authors.forename: Taishi
authors.initials: T
authors.lastname: Yonetsu
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan kaz@joy.email.ne.jp.
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Kakuta
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods / Q000401:mortality; D003326:Coronary Circulation / Q000502:physiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods* / Q000401:mortality; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: coronary artery disease; coronary flow reserve; fractional flow reserve; microvascular dysfunction; microvascular resistance; percutaneous coronary intervention