Change in fractional flow reserve after PCI could be prognostic of angina
Key takeaways:
- Percentage change in fractional flow reserve after percutaneous coronary intervention tied to less angina at follow-up.
- Improved FFR was also associated with improvements in patient-reported quality of life.
Increased change in fractional flow reserve at 3-month follow-up after PCI was moderately associated with less angina and improved quality of life, researchers reported.
“Understanding patient factors associated with post-PCI angina may support different approaches to revascularization. Conflicting data exist regarding the association between invasive coronary measurements and patient-reported outcome measures at follow-up,” Damien Collison, MB BCh, interventional cardiologist at West of Scotland Regional Heart and Lung Centre and Golden Jubilee National Hospital in Clydebank, U.K., and colleagues wrote. “In this analysis, the incidence and associates of angina at 3 months post-PCI were examined.”
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The present study is a post hoc analysis of the randomized controlled TARGET-FFR trial, which evaluated the efficacy of a physiology-guided incremental optimization strategy compared with standard angiographic guidance after PCI.
For the present analysis published in Circulation: Cardiovascular Interventions, Collison and colleagues assessed the patient and procedural factors associated with angina among 230 patients who underwent PCI. All participants completed the Seattle Angina Questionnaire (SAQ-7) and EuroQol-5 Dimension (EQ-5D-5L) questionnaires at baseline and 3 months and received masked intracoronary physiology assessments before and after PCI.
Angina after PCI was defined as a SAQ-7 score of less than 100.
After 3 months, 38.3% of the cohort reported angina. These patients had a higher incidence of active smoking, atrial fibrillation, prior MI or previous PCI compared with those without angina after PCI.
Patients with angina at 3 months had lower baseline SAQ (69.48 vs. 50.2; P < .001) and EQ-5D-5L scores (0.84 vs. 0.69; P < .001) compared with those without angina.
At 3-month follow-up, patients with angina after PCI had lower SAQ (64 vs. 95.16; P .001) and EQ-5D-5L index scores (0.69 vs. 0.91; P .001).
The researchers observed no significant between-group differences in angiography-based parameters of CAD severity before or after PCI.
FFR before PCI was lower among patients without angina at 3 months (0.56 vs. 0.62; P = .003), and the percentage change in FFR after PCI was moderately associated with angina frequency score at follow-up (r = 0.36; P < .0001), according to the study.
Moreover, angina was associated with less improvement in FFR after PCI (43.1% vs. 67%; P < .001).
“Among patients who had angina at baseline (Canadian Cardiovascular Society class I and above), pre-PCI, absolute and percentage delta FFR values had significant correlations with patient-reported outcome measures at follow-up. Post-PCI values had no correlation with angina or quality of life at follow-up indicating that ... pre-PCI values drove the magnitude of the change,” the researchers wrote. “Accordingly, this analysis from the TARGET-FFR randomized trial supports the concept that intracoronary physiology assessment can inform expectations of angina relief and quality of life improvement after stenting and thereby help to determine the appropriateness of PCI intended to alleviate symptoms.”
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