title: Impact of lesion characteristics on the prediction of optimal poststent fractional flow reserve.
abstract: BACKGROUND
  Poststent fractional flow reserve (FFR) is a useful indicator of optimal percutaneous coronary intervention, and higher poststent FFR is associated with favorable long-term clinical outcome. However, little is known about the factors influencing poststent FFR. The purpose of this study was to determine the impact of lesion characteristics on poststent FFR.
  
  
  METHODS
  For patients who had scheduled stent implantation for stable angina, FFR measurements at maximum hyperemia were performed before and after coronary stent implantation. As one of lesion characteristics, the FFR pressure drop pattern was evaluated and classified as either an abrupt or a gradual pattern according to the pullback curve of FFR.
  
  
  RESULTS
  A total of 205 lesions with physiological significant stenosis were evaluated. Fractional flow reserve value increased from 0.67±0.10 to 0.87±0.07 after stent implantation. Optimal poststent FFR was achieved in 75 lesions (36.6%). Logistic regression analysis demonstrated that optimal poststent FFR was positively correlated with an abrupt pressure drop pattern (hazard ratio [HR] 2.11, 95% CI 1.06-4.15, P=.03) and prestent FFR (HR 1.04, 95% CI 1.03-2.04, P=.03; per 0.1 increase), and negatively correlated with lesion localization to the left anterior descending artery (HR 0.18, 95% CI 0.09-0.36, P<.0001). The c statistic for predicting optimal poststent FFR was 0.763 (95% CI 0.702-0.819).
  
  
  CONCLUSIONS
  Abrupt pressure drop patterns, prestent FFR, and lesion localization to the left anterior descending artery were independent predictors of optimal poststent FFR.
authors.affiliation: Department of Cardiology, Aichi Medical University, Nagakute, Japan. Electronic address: hirohiko131@yahoo.co.jp.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Ando
authors.affiliation: Department of Cardiology, Aichi Medical University, Nagakute, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takashima
authors.affiliation: Department of Cardiology, Aichi Medical University, Nagakute, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Aichi Medical University, Nagakute, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Sakurai
authors.affiliation: Department of Cardiology, Aichi Medical University, Nagakute, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kumagai
authors.affiliation: Department of Cardiology, Aichi Medical University, Nagakute, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kurita
authors.affiliation: Department of Cardiology, Aichi Medical University, Nagakute, Japan.
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Waseda
authors.affiliation: Department of Cardiology, Aichi Medical University, Nagakute, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Amano
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013223:Statistics as Topic