Clinical and Physiological Outcomes of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients With Serial Stenoses Within One Coronary Artery

Objectives 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. (J Am Coll Cardiol Intv 2012;5:1013-8) (c) 2012 by the American College of Cardiology Foundation