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Usefulness of coronary pressure measurement for functional evaluation of drug-eluting stent restenosis.

Authors
Nam, CW; Rha, SW; Koo, BK; Doh, JH; Chung, WY; Yoon, MH; Tahk, SJ; Lee, BK; Lee, JB; Yoo, KD; Cho, YK; Chung, IS; Hur, SH; Kim, KB; Choi, CU; Oh, DJ
Citation
The American journal of cardiology, 107(12):1783-1786, 2011
Journal Title
The American journal of cardiology
ISSN
0002-91491879-1913
Abstract
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.
MeSH terms
AgedCoronary AngiographyCoronary Artery Disease/*therapyCoronary Restenosis/*diagnosis/physiopathology/radiography*Drug-Eluting StentsFemale*Fractional Flow Reserve, MyocardialHumansMaleMiddle Aged
DOI
10.1016/j.amjcard.2011.02.328
PMID
21481824
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
AJOU Authors
윤, 명호탁, 승제
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