Diagnostic accuracy of angiography-based vessel fractional flow reserve after chronic coronary total occlusion recanalization

Catheter Cardiovasc Interv. 2022 Nov;100(6):964-970. doi: 10.1002/ccd.30439. Epub 2022 Nov 2.


Background: Angiography-based vessel fractional flow reserve (vFFR) demonstrated a strong correlation with invasive fractional flow reserve (FFR) in both a pre- and post-percutaneous coronary intervention (PCI) setting. However, the role of vFFR and its correlation with post-PCI FFR in chronic coronary occlusions (CTO) has not been evaluated yet. We sought to investigate the diagnostic performance of post-PCI vFFR with post-PCI FFR as a reference in patients undergoing successful CTO PCI.

Methods: Between March 2016 and April 2020, a total of 80 patients from the FFR-SEARCH (prospective registry) and FFR REACT (randomized controlled trial) studies underwent successful CTO recanalization with post-PCI FFR measurements.

Results: A total of 50 patients (median age 66 (interquartile range [IQR]: 56-74) years, 76% were male) were eligible for the analysis. Median post-PCI FFR was 0.89 (IQR: 0.84-0.94), while median post-PCI vFFR was 0.91 (IQR: 0.85-0.94) (p 0.10). Suboptimal physiological results, defined as FFR and vFFR <0.90, were identified in 26 (52%) and in 21 (42%) patients, respectively. A strong correlation (r = 0.82) was found between vFFR and FFR with a mean bias of 0.013 ± 0.051. Receiver-operating characteristics curve analysis revealed an excellent accuracy of vFFR in predicting FFR <0.90 (area under the curve: 0.97; 95% confidence interval: 0.93-1.00).

Conclusion: Post-PCI vFFR shows a good correlation with post-PCI FFR and a high diagnostic accuracy for post-PCI FFR ≤0.90 in patients undergoing successful PCI of a CTO lesion.

Keywords: 3D-QCA; chronic total occlusion; coronary physiology; fractional flow reserve; percutaneous coronary intervention; post percutaneous coronary intervention physiology; quantitative coronary angiography; vessel fractional flow reserve.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Coronary Angiography / methods
  • Coronary Artery Disease* / diagnosis
  • Female
  • Fractional Flow Reserve, Myocardial* / physiology
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / methods
  • Predictive Value of Tests
  • Treatment Outcome