FFR following PCI tied to less angina and better quality of life: Analysis of TARGET-FFR study

According to the researchers, intracoronary physiologic assessments can help inform patient expectations about PCI benefits. They may even be used to take the patient off the table if FFR indicates that a stent placement won't help their symptoms. Explaining why FFR is being used at the outset helps manage patient expectations.

Angina affects twenty percent to 40% of patients after percutaneous coronary intervention, which is linked with depression, anxiety, reduced quality of life, and impaired physical function. Understanding procedural and patient factors associated with post-PCI angina may inform alternative approaches to treatment.

In their study published in Circulation: Cardiovascular Interventions, Damien Collison, Golden Jubilee National Hospital, Clydebank, United Kingdom, and colleagues aimed to identify different patient and procedural predictors of angina after PCI.

The analysis included two hundred thirty patients undergoing PCI who completed the European quality of life–5 dimension–5 level (EQ-5D-5L) questionnaires and the Seattle Angina Questionnaire (SAQ-7) at baseline and three months post-PCI.

Before and after stenting, patients received blinded intracoronary physiology assessments. A post hoc analysis of the TARGET-FFR trial was performed to compare clinical and procedural characteristics in patients with and without post-PCI angina, defined by follow-up SAQ-angina frequency score <100.

The study led to the following findings:

· Eighty-eight of 230 patients reported angina three months post-PCI and had a higher incidence of active smoking, atrial fibrillation, and previous myocardial infarction or PCI history.

· Compared with patients with no angina at follow-up, they had lower baseline SAQ summary scores (69.48±24.12 versus 50.20±22.59) and EQ-5D-5L health index scores (0.84±0.15 versus 0.69±0.22).

· Pre-PCI fractional flow reserve (FFR) was lower among patients with no post-PCI angina (0.56±0.15 versus 0.62±0.13).

· Percentage change in FFR after PCI had a moderate correlation with angina frequency score at follow-up (r=0.36).

· Patients with post-PCI angina had less improvement in FFR (43.1±33.5% versus 67.0±50.7%).

· There were no between-group differences in post-PCI FFR, coronary flow reserve, or corrected index of microcirculatory resistance.

· Patients with post-PCI angina had lower SAQ-summary scores (64.01±22 versus 95.16±8.72) and EQ-5D-5L index scores (0.69±0.26 versus 0.91±0.17) at follow-up.

The researchers wrote, "Larger improvements in FFR after PCI are associated with better quality of life and less angina at follow-up."

"Intracoronary physiology assessment in patients with stable symptoms can inform expectations of angina relief and quality of life improvement after stenting and thereby help to determine PCI's appropriateness."

Reference:

The "Angina After Percutaneous Coronary Intervention: Patient and Procedural Predictors" study was published in Circulation: Cardiovascular Interventions. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.122.012511