Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty

G. Jan Willem Bech, Nico H.J. Pijls, Bernard de Bruyne, Kathinka H. Peels, H. Rolf Michels, Hans J.R.M. Bonnier, Jacques J. Koolen

Research output: Contribution to journalArticleAcademicpeer-review

133 Citations (Scopus)

Abstract

Background - After regular coronary balloon angioplasty, it would be helpful to identify those patients who have a low cardiac event rate. Coronary angiography alone is not sensitive enough for that purpose, but it has been suggested that the combination of optimal angiographic and optimal functional results indicates a low restenosis chance. Pressure-derived myocardial fractional flow reserve (FFR) is an index of the functional severity of the residual epicardial lesion and could be useful for that purpose. Methods and Results - In 60 consecutive patients with single-vessel disease, balloon angioplasty was performed by use of a pressure instead of a regular guide wire. Both quantitative coronary angiography (QCA) and measurement of FFR were performed 15 minutes after the procedure. A successful angioplasty result, defined as a residual diameter stenosis (DS) <50%, was achieved in 58 patients. In these patients, DS and FFR, measured 15 minutes after PTCA, were analyzed in relation to clinical outcome. In those 26 patients with both optimal angiographic (residual DS by QCA ≤35%) and optimal functional (FFR ≥0.90) results, event-free survival rates at 6, 12, and 24 months were 92 ± 5%, 92 ± 5%, and 88 ± 6%, respectively, versus 72 ± 8%, 69 ± 8%, and 59 ± 9%, respectively, in the remaining 32 patients in whom the angiographic or functional result or both were suboptimal (P = 0.047, P = 0.028, and P = 0.014, respectively). Conclusions - In patients with a residual DS ≤35% and FFR ≥0.90, clinical outcome up to 2 years is excellent. Therefore, there is a complementary value of coronary angiography and coronary pressure measurement in the evaluation of PTCA result.

Original languageEnglish
Pages (from-to)883-888
Number of pages6
JournalCirculation
Volume99
Issue number7
DOIs
Publication statusPublished - 23 Feb 1999
Externally publishedYes

Keywords

  • Angioplasty
  • Balloon
  • Blood flow
  • Pressure
  • Prognosis

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