The Study Of Blood Flow Reserve Fraction Immediately After Drug-eluting Stent Implantation To Predict Clinical Events

Part ?:Post-DES FFR Predicts the Clinical Outcomes,A Prospective,Multicenter,Registry Study[DK CRUSH-?]Objectives:This study aimed to investigate the cut-off of post-DES FFR for prediction of 1-to 3-year target vessel failure(TVF).Background:Fractional flow reserve(FFR)immediately after a drug-eluting stent(DES)implantation correlates with clinical events.However,the cut-off of post-DES FFR for predicting long-total term clinical events remains understudied.Methods:Between May 2012 and September 2013,a of 1476 patients who had FFR<0.8 at maximal and underwent DES implantation were prospectively studied in 9 centers.Post-DES FFR was repeat measured.The primary endpoint was the 1-year TVF rate after procedures.Receiver Operator Curve was used to calculate the post-DES FFR value for TVF,then patients were classified based on this value and folio wed-up for three years.Results:By the end of the first year,88(6.0%)TVFs were recorded.A post-DES FFR<0.88 strongly correlated with TVF.Disease on left anterior descending artery(LAD),stent length and diameter were independent factors of impaired post-DES FFR,whereas post-procedure FFR<0.88 was the only predictor of TVF,with 40(4.0%)TVFs in FFR>0.88 and 48(8.0%)in FFR<0.88 group(p=0.001),mainly driven by target vessel revascularization(3.8%vs.8.8%,p=0.005)and cardiac death(0.2%vs.1.3%,p=0.017).The difference in TVF between two groups was maintained through three-year follow-up(p=0.002).For patients with LAD lesions,a post-DES FFR<0.905 predicted one-year TVF.Conclusions:Post-DES FFR strongly correlated with TVF rate.Mechanisms attributed to and treatments for impaired FRR after stenting should be studied in future studies.Part ?:The Prognostic Value of Post Drug-eluting Stent FFR in left anterior descending artery lesion(The sub-study of DK ?)Objective:This study aimed at investigating prognostic value of post drug-eluting stent(DES)fractional flow reserve(FFR)for major adverse cardiac events(MACE)in left anterior descending artery(LAD)setting.Background:The role of the post-DES FFR for MACE in LAD was not clear.Methods:Post procedure FFR was evaluated immediately in 435 patients after DES implantation in LAD.The primary endpoint was adverse events composed of cardiac death,acute myocardial infarction,target vessel revascularization(TVR),coronary artery bypass grafting(CABG)at 12±1 months follow-up.Receiver-operating characteristic(ROC)curve analysis was performed to assess the optimal cutoff value of post-DES FFR in LAD for predicting MACE,Univariate and multivariate Cox proportional hazards regression was used to identify independent MACE predictors.Results:The post-DES FFR was?0.87 in 155 patients.During follow-up period,3.2%of FFR>0.87 patients and 10.3%of FFR?0.87 patients experience TVR(p<0.001).On Cox multivariate analysis,Post-DES FFR?0.87 remained an independent significant predictor of MACE(hazard ratio 2.734,95%confidence interval(Cl)1.16 to 6.446,p=0.022).Left ventricular ejection fraction(LVEF)<50%(HR:5.892,95%Cl:2.143-16.2,P=0.001)and diabetes mellitus(HR:2.734,95%Cl:1.18-6.334,p=0.019)was other predictors for MACE.Post-DES FFR cutoff of 0.87 had the best predictive accuracy for MACE(AUC0.70,sensitivity 0.60,specificity 0.737,p=0.001)and the target vessel revascularization(TVR)(AUC0.713,sensitivity 0.609,specificity 0.735,p<0.001)in LAD by the receiver operating characteristic curves(ROC)analysis.Conclusions:Post-DES FFR is useful as an indicator of optimal PCI in LAD.