JACC Cardiovasc Interv. 2025 Dec 8;18(23):2863-2874. doi: 10.1016/j.jcin.2025.09.034.
ABSTRACT
BACKGROUND: Fractional flow reserve (FFR) following percutaneous coronary intervention (PCI) reflects the degree of flow limitation caused by residual disease after PCI.
OBJECTIVES: The aim of this study was to evaluate the long-term and temporal prognostic impact of post-PCI FFR on clinical outcomes over a 5-year follow-up period.
METHODS: A total of 2,128 patients who underwent angiographically successful drug-eluting stent implantation with post-PCI FFR measurement and completed 5 years of follow-up were analyzed. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization (TVR).
RESULTS: The risk for TVF was higher in the low post-PCI FFR group than in the high post-PCI FFR group at 5 years (adjusted HR [aHR]: 1.95; 95% CI: 1.46-2.62; P < 0.001). The higher risk for TVF in the low post-PCI FFR group compared with the high post-PCI FFR group was prominent within 3 years after PCI (aHR: 2.00; 95% CI: 1.44-2.78; P < 0.001) and attenuated 3 years after PCI (aHR: 1.80; 95% CI: 0.94-3.44; P = 0.076). Contrary to other clinical outcomes, only TVR in the nonstented segment showed a higher risk in the low post-PCI FFR group compared with the high post-PCI within (aHR: 2.78; 95% CI: 1.43-5.39; P = 0.003) and beyond (aHR: 6.73; 95% CI: 2.02-22.37; P = 0.002) 3 years after PCI.
CONCLUSIONS: The prognostic impact of post-PCI FFR on TVF persisted over a 5-year follow-up period, but it was more prominent during the first 3 years after PCI. In contrast, its impact on TVR in the nonstented segments was sustained throughout the entire 5-year follow-up period. (International Post-PCI FFR Extended Registry; NCT05672862).
PMID:41371783 | DOI:10.1016/j.jcin.2025.09.034