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(Circulation. 1999;99:883-888.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Usefulness of Fractional Flow Reserve to Predict Clinical Outcome After Balloon Angioplasty
From the Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands, and the Cardiovascular Center, Aalst, Belgium (B.D.B.).
Correspondence to Nico H.J. Pijls, MD, PhD, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, Netherlands. E-mail G.Bech{at}inter.NL.net
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.
Key Words: pressure • balloon • angioplasty • blood flow • prognosis
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