Coronary artery disease
Usefulness of Coronary Pressure Measurement for Functional Evaluation of Drug-Eluting Stent Restenosis

https://doi.org/10.1016/j.amjcard.2011.02.328Get rights and content

Despite the widespread adoption of drug-eluting stent (DES) implantation, the optimal treatment of DES failures remains challenging. The present study evaluated the relation between quantitative angiography and the fractional flow reserve (FFR) in restenotic lesions after DES implantation and the efficacy of FFR in determining whether to treat these lesions. To assess their functional significance, the coronary pressure-derived FFR was measured in 50 DES restenotic lesions (49 patients). Additional intervention was performed in lesions with a FFR <0.8. Major adverse cardiac events were assessed at 12 months after the reintervention procedure. The mean percent diameter stenosis (%DS) was 58 ± 13%. Of the 50 lesions, 20 (40%) were deferred without additional intervention. The FFR and %DS had a negative correlation (r = −0.61, p <0.001). However, when only the lesions with diffuse-type restenosis (15 lesions) were analyzed, the degree of correlation decreased (r = −0.56, p = 0.12). Although most lesions (89%) with a %DS of ≥70 had significant functional ischemia, among 41 lesions with a %DS <70, only 20 (49%) had demonstrated functional patency. The incidence of adverse events during the 12 months of follow-up after FFR-guided treatment was 18.0% (23.3% in the FFR <0.80 group and 10.0% in FFR ≥0.80 group). In conclusion, a discrepancy was found between functional ischemia measured by the FFR and the angiographic %DS, in particular, in moderate- or diffuse-type restenotic lesions after DES implantation. The outcome of FFR-guided deferral in patients with DES in-stent restenosis seems favorable.

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Methods

The present prospective observational study enrolled patients from 6 interventional centers in Korea who had undergone measurement of coronary pressure-derived FFR to assess the functional significance of restenotic lesions (visual percentage diameter stenosis [%DS] ≥40% in stent or 5 mm adjacent to either of the 2 stent edges) after DES implantation. The lesion should have no documented evidence of associated ischemia on noninvasive tests (not performed, negative, inadequate, or not evaluable

Results

To assess functional severity, the FFR was measured in 50 restenotic lesions (49 patients) after DES implantation. Of the 49 patients, 31 were referred to the catheterization laboratory without a previous noninvasive test, including 38% of the symptomatic patients. The others had had nondiagnostic test results. Three type of DESs were implanted at the index procedure: sirolimus-eluting stents, paclitaxel-eluting stents, and zotarolimus-eluting stents (34%, 53%, and 13% respectively). The mean

Discussion

The major findings in the present study were that a discrepancy exists between functional ischemia measured by FFR and angiographic %DS, in particular, in moderate- or diffuse-type restenotic lesions after DES implantation, and FFR-guided intervention can be used to determine the treatment of these lesions.

Because the patients with DES restenosis had a greater prevalence of diabetes and a larger stent length, together with the expectation that the final result obtained after treatment of the

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This study was supported by research grant 2010-02 from the Korean Society of Interventional Cardiology, Seoul, Korea.

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