Utilizing Post-Intervention Fractional Flow Reserve to Optimize Acute Results and the Relationship to Long-Term Outcomes

OBJECTIVES 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. BACKGROUND 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. METHODS Consecutive patients undergoing PCI who had pre- and post-PCI FFR evaluations were followed for major adverse cardiovascular events (MACE). RESULTS 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. CONCLUSIONS 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. (C) 2016 by the American College of Cardiology Foundation.