Abstract
3D coronary angiography-based vessel fractional flow reserve (vFFR) proved to be an accurate diagnostic alternative to invasively measured pressure wire based fractional flow reserve (FFR). The ability to compute post-PCI vFFR using pre-PCI vFFR virtual stent analysis is unknown. We aimed to assess the feasibility and diagnostic accuracy of pre-PCI vFFR virtual stenting analysis (residual vFFR) with post-PCI FFR as a reference. This is an observational, single-center retrospective cohort study including consecutive patients from the FFR-SEARCH registry. We blindly calculated residual vFFR from pre-PCI angiograms and compared them to invasive pressure-wire based post-PCI FFR. Inclusion criteria involved presentation with either stable or unstable angina or non-ST elevation myocardial infarction (NSTEMI), ≥1 significant stenosis in one of the epicardial coronary arteries (percentage diameter stenosis of >70% by QCA or hemodynamically relevant stenosis with FFR ≤0.80) and pre procedural angiograms eligible for vFFR analysis. Exclusion criteria comprised patients with ST elevation myocardial infarction (STEMI), coronary bypass grafts, cardiogenic shock or severe hemodynamic instability. Eighty-one pre-PCI residual vFFR measurements were compared to post-PCI FFR and post-PCI vFFR measurements. Mean residual vFFR was 0.91 ± 0.06, mean post-PCI FFR 0.91 ± 0.06 and mean post-PCI vFFR was 0.92 ± 0.05. Residual vFFR showed a high linear correlation (r = 0.84) and good agreement (mean difference (95% confidence interval): 0.005 (−0.002–0.012)) with post-PCI FFR, as well as with post-PCI-vFFR (r = 0.77, mean difference −0.007 (−0.015–0.0003)). Residual vFFR showed good accuracy in the identification of lesions with post-PCI FFR < 0.90 (sensitivity 94%, specificity 71%, area under the curve (AUC) 0.93 (95% CI: 0.86–0.99), p < 0.001). Virtual stenting using vFFR provided an accurate estimation of post-PCI FFR and post-PCI vFFR. Further studies are needed to prospectively validate a vFFR-guided PCI strategy.
Highlights
Functional physiological lesion assessment after angiographically successful percutaneous coronary intervention (PCI) proved to have significant prognostic value [1–10].individuals with higher post-PCI fractional flow reserve (FFR) values had improved prognosis [8,10–15]. 4.0/).Vessel fractional flow reserve has been recently introduced into the armamentarium of catheterization laboratory practice aiming to simplify functional lesion assessment [5,16]
Its good correlation to invasive FFR, both in a pre- and post-PCI setting, was recently demonstrated [17–26]. vessel fractional flow reserve (vFFR) allows computation of FFR using a 3D reconstruction of coronary angiography without the necessity for a pressure wire or hyperemic agent [16,18]
We present the ‘Virtual stenting’ vFFR study that aimed to assess the diagnostic performance of residual vFFR (‘virtual stenting’ vFFR)—performed using the prePCI angiogram—against invasively measured post stenting FFR in a consecutive series of patients
Summary
Functional physiological lesion assessment after angiographically successful percutaneous coronary intervention (PCI) proved to have significant prognostic value [1–10].individuals with higher post-PCI fractional flow reserve (FFR) values had improved prognosis [8,10–15]. 4.0/).Vessel fractional flow reserve (vFFR) has been recently introduced into the armamentarium of catheterization laboratory practice aiming to simplify functional lesion assessment [5,16]. Functional physiological lesion assessment after angiographically successful percutaneous coronary intervention (PCI) proved to have significant prognostic value [1–10]. Individuals with higher post-PCI fractional flow reserve (FFR) values had improved prognosis [8,10–15]. Vessel fractional flow reserve (vFFR) has been recently introduced into the armamentarium of catheterization laboratory practice aiming to simplify functional lesion assessment [5,16]. Its good correlation to invasive FFR, both in a pre- and post-PCI setting, was recently demonstrated [17–26]. VFFR allows computation of FFR using a 3D reconstruction of coronary angiography without the necessity for a pressure wire or hyperemic agent [16,18]. Recent developments in the vFFR software allowed us to simulate the effect of ‘virtual’ PCI and estimate post-PCI FFR (residual vFFR). The diagnostic performance of residual vFFR assessment using baseline angiograms has not been evaluated
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