FFR result post PCI is suboptimal in long diffuse coronary artery disease

Abstract

The FFR result post PCI was suboptimal in the majority of patients treated with long DES and was particularly poor when the total stent length exceeded 50 mm.

Per-Vessel Level Analysis of Fractional Flow Reserve and Instantaneous Wave-Free Ratio Discordance ― Insights From the AJIP Registry ―

“…5 Conversely, they emphasized the balance between risks and benefits of longstenting in the diffuse lesions with FFR−/iFR+ discordance, which may not achieve optimal post-stent physiologic results or favorable long-term outcomes. 6 The present study further strengthens this recommendation, as the LAD stenosis subtends a larger myocardial territory 7 and the prognosis of coronary artery disease is largely determined by the amount of ischemic myocardium at risk. 8 The insights from this study suggest one explanation of the results of the DEFINE-FLAIR LAD sub-analysis, which demonstrated superior clinical outcomes among patients deferred with iFR in the LAD compared to FFR.…”

Evaluation of different surgical modalities for coronary reconstruction of diffusely diseased left anterior descending artery

“…With advances in PCI, patients now referred to CABG are becoming more complex with multiple comorbidities as well as less attractive target vessels. Diffuse coronary artery disease is a problem that faces surgeons now with increasing frequency since in this subset of patients PCI produces less than optimal results [5] . In up to 25% of patients with diffuse coronary disease conventional CABG as well would not optimally revascularize the ischemic territories [6] .…”

Fractional Flow Reserve following Percutaneous Coronary Intervention

“…Baranauskas et al, however, suggested that this did not translate to patients with diffuse long segment coronary artery lesions requiring long (30-49 mm) or ultralong DES (≥50 mm). In this single-centre prospective study including 74 patients who received long or ultra-long DES, FFR >0.90 immediately after PCI was achieved only in 28.4% (21/74) of patients, of whom only two had received ultralong DES [43]. At 9-month follow-up, 61 patients had FFR measured; 23% of patients had an FFR >0.90, restenosis rate was 15.1% by functional assessment, and target lesion revascularization occurred in 8.1% of patients [43].…”

“…In this single-centre prospective study including 74 patients who received long or ultra-long DES, FFR >0.90 immediately after PCI was achieved only in 28.4% (21/74) of patients, of whom only two had received ultralong DES [43]. At 9-month follow-up, 61 patients had FFR measured; 23% of patients had an FFR >0.90, restenosis rate was 15.1% by functional assessment, and target lesion revascularization occurred in 8.1% of patients [43]. e rate of achieving FFR >0.90 immediately after PCI and at 9month follow-up is considerably lower than that reported in the previous studies on shorter stents, suggesting that it is more challenging to achieve satisfactory post-PCI FFR values in patients treated with long or ultra-long DES.…”