Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction

Ki Hong Choi; Woochan Kwon; Doosup Shin; Seung-Hun Lee; Doyeon Hwang; Jinlong Zhang; Chang-Wook Nam; Eun-Seok Shin; Joon-Hyung Doh; Shao-Liang Chen; Tsunekazu Kakuta; Gabor G Toth; Zsolt Piroth; Abdul Hakeem; Barry F Uretsky; Yohei Hokama; Nobuhiro Tanaka; Hong-Seok Lim; Tsuyoshi Ito; Akiko Matsuo; Lorenzo Azzalini; Massoud A Leesar; Joost Daemen; Damien Collison; Carlos Collet; Bernard De Bruyne; Bon-Kwon Koo; Taek Kyu Park; Jeong Hoon Yang; Young Bin Song; Joo-Yong Hahn; Seung-Hyuk Choi; Hyeon-Cheol Gwon; Joo Myung Lee

doi:10.1016/j.jacasi.2023.10.009

Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction

JACC Asia. 2023 Dec 12;4(3):229-240. doi: 10.1016/j.jacasi.2023.10.009. eCollection 2024 Mar.

Authors

Ki Hong Choi¹, Woochan Kwon¹, Doosup Shin², Seung-Hun Lee³, Doyeon Hwang⁴, Jinlong Zhang⁵, Chang-Wook Nam⁶, Eun-Seok Shin⁷, Joon-Hyung Doh⁸, Shao-Liang Chen⁹, Tsunekazu Kakuta¹⁰, Gabor G Toth¹¹, Zsolt Piroth¹², Abdul Hakeem¹³, Barry F Uretsky¹⁴, Yohei Hokama¹⁵, Nobuhiro Tanaka¹⁶, Hong-Seok Lim¹⁷, Tsuyoshi Ito¹⁸, Akiko Matsuo¹⁹, Lorenzo Azzalini²⁰, Massoud A Leesar²¹, Joost Daemen²², Damien Collison²³, Carlos Collet²⁴, Bernard De Bruyne²⁴, Bon-Kwon Koo⁴, Taek Kyu Park¹, Jeong Hoon Yang¹, Young Bin Song¹, Joo-Yong Hahn¹, Seung-Hyuk Choi¹, Hyeon-Cheol Gwon¹, Joo Myung Lee¹

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
² Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA.
³ Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
⁴ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
⁵ Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁶ Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
⁷ Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
⁸ Department of Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea.
⁹ Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
¹⁰ Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
¹¹ University Heart Centre Graz, Medical University Graz, Austria.
¹² Gottsegen National Cardiovascular Centre, Budapest, Hungary.
¹³ Division of Cardiovascular Diseases and Hypertension, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.
¹⁴ Central Arkansas VA Health System/University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
¹⁵ Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
¹⁶ Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
¹⁷ Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
¹⁸ Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
¹⁹ Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
²⁰ Division of Cardiovascular Diseases, University of Alabama, Birmingham, Alabama, USA.
²¹ Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands.
²² West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.
²³ Cardiovascular Center Aalst, Aalst, Belgium.
²⁴ Department of Cardiology, University of Lausanne, Switzerland.

Abstract

Background: Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified.

Objectives: This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF).

Methods: A total of 2,965 patients with available LVEF were selected from the POST-PCI FLOW (Prognostic Implications of Physiologic Investigation After Revascularization with Stent) international registry of patients with post-PCI FFR measurement. The primary outcome was a composite of cardiac death or target-vessel myocardial infarction (TVMI) at 2 years. The secondary outcome was target-vessel revascularization (TVR) and target vessel failure, which was a composite of cardiac death, TVMI, or TVR.

Results: Post-PCI FFR was independently associated with the risk of target vessel failure (per 0.01 decrease: HR_adj: 1.029; 95% CI: 1.009-1.049; P = 0.005). Post-PCI FFR was associated with increased risk of cardiac death or TVMI (HR_adj: 1.145; 95% CI: 1.025-1.280; P = 0.017) among patients with LVEF ≤40%, and with that of TVR in patients with LVEF >40% (HR_adj: 1.028; 95% CI: 1.005-1.052; P = 0.020). Post-PCI FFR ≤0.80 was associated with increased risk of cardiac death or TVMI in the LVEF ≤40% group and with that of TVR in LVEF >40% group. Prognostic impact of post-PCI FFR for the primary outcome was significantly different according to LVEF (P_interaction = 0.019).

Conclusions: Post-PCI FFR had differential prognostic impact according to LVEF. Residual ischemia by post-PCI FFR ≤0.80 was a prognostic indicator for cardiac death or TVMI among patients with patients with LVEF ≤40%, and it was associated with TVR among patients with patients with LVEF>40%. (Prognostic Implications of Physiologic Investigation After Revascularization with Stent [POST-PCI FLOW]; NCT04684043).

Keywords: drug-eluting stent(s); fractional flow reserve; left ventricular ejection fraction; percutaneous coronary intervention; prognosis.

Associated data

ClinicalTrials.gov/NCT04684043