Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty.

BACKGROUND After regular coronary balloon angioplasty, it would be helpful to identify those patients who have a low cardiac event rate. Coronary angiography alone is not sensitive enough for that purpose, but it has been suggested that the combination of optimal angiographic and optimal functional results indicates a low restenosis chance. Pressure-derived myocardial fractional flow reserve (FFR) is an index of the functional severity of the residual epicardial lesion and could be useful for that purpose. METHODS AND RESULTS In 60 consecutive patients with single-vessel disease, balloon angioplasty was performed by use of a pressure instead of a regular guide wire. Both quantitative coronary angiography (QCA) and measurement of FFR were performed 15 minutes after the procedure. A successful angioplasty result, defined as a residual diameter stenosis (DS) <50%, was achieved in 58 patients. In these patients, DS and FFR, measured 15 minutes after PTCA, were analyzed in relation to clinical outcome. In those 26 patients with both optimal angiographic (residual DS by QCA </=35%) and optimal functional (FFR >/=0.90) results, event-free survival rates at 6, 12, and 24 months were 92+/-5%, 92+/-5%, and 88+/-6%, respectively, versus 72+/-8%, 69+/-8%, and 59+/-9%, respectively, in the remaining 32 patients in whom the angiographic or functional result or both were suboptimal (P=0.047, P=0.028, and P=0.014, respectively). CONCLUSIONS In patients with a residual DS </=35% and FFR >/=0.90, clinical outcome up to 2 years is excellent. Therefore, there is a complementary value of coronary angiography and coronary pressure measurement in the evaluation of PTCA result.

[1]  M. Leon,et al.  Patterns and mechanisms of in-stent restenosis. A serial intravascular ultrasound study. , 1996, Circulation.

[2]  M. Menegus,et al.  Fractional Flow Reserve , 1997 .

[3]  J. Hodgson,et al.  Intracoronary ultrasound imaging: correlation of plaque morphology with angiography, clinical syndrome and procedural results in patients undergoing coronary angioplasty. , 1993, Journal of the American College of Cardiology.

[4]  J. Tijssen,et al.  Luminal narrowing after percutaneous transluminal coronary angioplasty. A study of clinical, procedural, and lesional factors related to long-term angiographic outcome. Coronary Artery Restenosis Prevention on Repeated Thromboxane Antagonism (CARPORT) Study Group. , 1993, Circulation.

[5]  E L Bolson,et al.  Experimental Validation of Quantitative Coronary Arteriography for Determining Pressure-Flow Characteristics of Coronary Stenosis , 1982, Circulation.

[6]  M. Leon,et al.  Remodeling of human coronary arteries undergoing coronary angioplasty or atherectomy. , 1997, Circulation.

[7]  Antonio Colombo,et al.  Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II) , 1998, The Lancet.

[8]  M. Leon,et al.  Intravascular ultrasound predictors of restenosis after percutaneous transcatheter coronary revascularization. , 1996, Journal of the American College of Cardiology.

[9]  J. Bartunek,et al.  Relation between myocardial fractional flow reserve calculated from coronary pressure measurements and exercise-induced myocardial ischemia. , 1995, Circulation.

[10]  J. Melin,et al.  Diagnostic Value of Exercise Electrocardiography and Thallium Myocardial Scintigraphy in Patients Without Previous Myocardial Infarction: A Bayesian Approach , 1981, Circulation.

[11]  W. Wijns,et al.  Simultaneous coronary pressure and flow velocity measurements in humans. Feasibility, reproducibility, and hemodynamic dependence of coronary flow velocity reserve, hyperemic flow versus pressure slope index, and fractional flow reserve. , 1996, Circulation.

[12]  P W Serruys,et al.  Incidence of restenosis after successful coronary angioplasty: a time-related phenomenon. A quantitative angiographic study in 342 consecutive patients at 1, 2, 3, and 4 months. , 1988, Circulation.

[13]  W. Wijns,et al.  Long-term follow-up after deferral of percutaneous transluminal coronary angioplasty of intermediate stenosis on the basis of coronary pressure measurement. , 1998, Journal of the American College of Cardiology.

[14]  J. Ritchie,et al.  Myocardial imaging with 201thallium: an analysis of clinical usefulness based on Bayes' theorem. , 1978, Seminars in nuclear medicine.

[15]  E. Topol,et al.  A call for provisional stenting: the balloon is back! , 1998, Circulation.

[16]  M. Kern,et al.  From research to clinical practice: current role of intracoronary physiologically based decision making in the cardiac catheterization laboratory. , 1997, Journal of the American College of Cardiology.

[17]  E Fleck,et al.  Prognostic value of intracoronary flow velocity and diameter stenosis in assessing the short- and long-term outcomes of coronary balloon angioplasty: the DEBATE Study (Doppler Endpoints Balloon Angioplasty Trial Europe). , 1997, Circulation.

[18]  W Siegenthaler,et al.  Long-term follow-up after percutaneous transluminal coronary angioplasty. The early Zurich experience. , 1987, The New England journal of medicine.

[19]  P. H. van der Voort,et al.  Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. , 1996, The New England journal of medicine.

[20]  P. H. van der Voort,et al.  Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. , 1995, Circulation.

[21]  J. Tobis,et al.  Morphological Effects of Coronary Balloon Angioplasty In Vivo Assessed by Intravascular Ultrasound Imaging , 1992, Circulation.

[22]  R. Peters,et al.  Prediction of restenosis after coronary balloon angioplasty. Results of PICTURE (Post-IntraCoronary Treatment Ultrasound Result Evaluation), a prospective multicenter intracoronary ultrasound imaging study. , 1997, Circulation.

[23]  Morphological Effects of Coronary Balloon Angioplasty In Vivo Assessed by Intravascular Ultrasound Imaging , 1992 .

[24]  P. Teirstein,et al.  A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. , 1994, The New England journal of medicine.

[25]  J. J. Gerbrands,et al.  Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms. , 1985, Circulation.

[26]  B Meier,et al.  Restenosis after successful coronary angioplasty in patients with single-vessel disease. , 1986, Circulation.

[27]  J. Koolen,et al.  Quantification of recruitable coronary collateral blood flow in conscious humans and its potential to predict future ischemic events. , 1995, Journal of the American College of Cardiology.

[28]  W Rutsch,et al.  A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. , 1994, The New England journal of medicine.

[29]  P J de Feyter,et al.  Technologic considerations and practical limitations in the use of quantitative angiography during percutaneous coronary recanalization. , 1994, Progress in cardiovascular diseases.