Clinical and angiographic predictors of persistently ischemic fractional flow reserve after percutaneous revascularization

Aims Despite optimal angiographic results after percutaneous coronary intervention (PCI), some lesions may continue to produce ischemia under maximal hyperemia. We evaluated the factors associated with persistently ischemic fractional flow reserve (FFR) after angiographically successful PCI. Methods and results A total of 574 consecutive patients with 664 lesions undergoing PCI who had FFR pre- and post-PCI were analyzed. Percutaneous coronary intervention led to effective ischemia reduction from pre-FFR (0.65 ± 0.14) to post-FFR (0.87 ± 0.08; ∆FFR 0.22 ± 0.16, P < .001). There were 63 (9.5%) lesions with a persistently ischemic FFR of ≤0.80 despite optimal angiographic PCI results. Multivariate analysis revealed the presence of diffuse disease (odds ratio [OR] 3.54, 95% CI 1.80-6.94, P < .01), left anterior descending artery PCI (OR 8.35, 95% CI 3.82-18.27, P < .01), use of intravenous adenosine for inducing hyperemia (OR 3.95, 95% CI 2.0-7.84, P < .01), and pre-PCI FFR (OR 0.03, 95% CI 0.004-0.23, P < .01) as independent predictors of persistently ischemic FFR (≤0.80) after PCI. The predictive accuracy of this model was robust, with an area under the curve of 0.85 (95% CI 0.82-0.88). Conclusion Multiple factors are associated with persistently ischemic FFR after angiographically optimal PCI. It is recommended that in lesions with the above-identified factors, FFR should be remeasured after PCI, and if abnormal, further measures should be undertaken for functional optimization.