Low vessel fractional flow reserve after percutaneous coronary intervention to fail

Both fractional flow reserve and non-hyperemic pressure ratios are widely used to assess the hemodynamic importance of intermediate coronary artery lesions. While the specific merits of each of these physiological indices have been mainly validated in a pre-percutaneous coronary intervention (PCI) setting, there is increasing interest in the use of either fractional flow reserve or non-hyperemic pressure ratios to assess the direct impact of stent placement on post percutaneous coronary intervention physiology. 

The FAST Outcome study is a retrospective cohort study in which patients were recruited from the P- SEARCH registry. The study is published in International Journal of Cardiology. The study aimed to assess the prognostic value of post percutaneous coronary intervention and the incidence of target vessel failure, a composite endpoint of cardiovascular death, spontaneous target vessel myocardial infarction and target vessel revascularization at 5 years follow-up.

Participants were a age of 65 years, 18.2% were diabetic, and 29.1% presented with stable angina. Vessels were categorized into tertiles based on post- percutaneous coronary intervention vessel fractional flow reserve low ( <0.88), middle ( 0.88–0.93), and upper (≥0.94). Vessels in the lower and middle tertile were more often left anterior descending and had smaller stent diameters.

Vessels in the lower and middle tertile had a higher risk of target vessel failure as compared to vessels in the upper tertile (24.6% and 21.5% vs. 17.1% and 1.58 at 5-years follow-up. Additionally, vessels in the lower tertile had higher rates of target vessel revascularization as compared to vessels in the higher tertile (12.6% vs. 6.5%). Researchers concluded that Lower post - percutaneous coronary intervention vessel fractional flow reserve values are associated with a significantly increased risk of target vessel failure and target vessel revascularization at 5-years follow-up.