bari 2 d | Dr.S.Venkatesan MD

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What happens to FFR after stenting ?

Posted in Uncategorized, tagged acc aha, bari 2 d, courage study, eapci, epicardial myocardial dissociiation, es guideinnedmt, ffr, ffr rfr qfr, ffr vs oct, ISCHEMIA trial, medical management for cad, myocardial revascularisation, ORBITA study on July 8, 2023|

A simple question with mammoth repercussions in the revascularization world.

How was the question ? Was it difficult ?

Don’t worry, it wouldn’t be the same even for elite cardiology experts worldwide. It is not a Himalayan task, though, to find an answer. All it requires is a simple FFR run through pre and post PCI (Now RFR, iFR, QFR). Surprisingly, very few inquisitive minds wanted to do this. I can find 5 related papers. The fifth one is very specific: REPEAT-FFR study. Go through at least that one paper and find the answer yourself.

Cardiology fellows it is worth reading about this important study , might be asked in exams.

Final message

The conclusions from these studies are not really baffling, but demand a lot of academic cleansing of our understanding about the relationship between epicardial patency and microvascular flow.”It is obvious from these studies that epicardial PCI never guarantees good revascularization with a FFR backing “

Every cardiologist should ask this question before they scrub, whether the PCI, they are going to do today, would improve the net-myocardial flow, LV function or symptoms . Are we doing justice to our patient (or blindly practicing science) who is quietly lying on the table, with a mix of anxiety and trust, with a complete belief that what they are undergoing is a life-changing or life-saving procedure.

Further, it is our duty to restore the lost glory to the defamed , stigmatised medical management of CAD & Impress our patients that “All that, doesn’t glitter could be pure gold as well”

Reference

1 Pijls NH, Klauss V, Siebert U, Powers E, Takazawa K, Fearon WF, Escaned J, Tsurumi Y, Akasaka T, Samady H, De Bruyne B; Fractional Flow Reserve (FFR) Post-Stent Registry Investigators. Coronary pressure measurement after stenting predicts adverse events at follow-up: a multicenter registry. Circulation 2002;105:2950-4

2. Agarwal SK, Kasula S, Hacioglu Y, Ahmed Z, Uretsky BF, Hakeem A. Utilizing Post-Intervention Fractional Flow Reserve to Optimize Acute Results and the Relationship to Long-Term Outcomes. JACC Cardiovasc Interv 2016;9:1022-31

3. Rimac G, Fearon WF, De Bruyne B, Ikeno F, Matsuo H, Piroth Z, Costerousse O, Bertrand OF. Clinical value of post-percutaneous coronary intervention fractional flow reserve value: A systematic review and meta-analysis. Am Heart J 2017;183:1-9

4. Wolfrum M, De Maria GL, Benenati S, Langrish J, Lucking AJ, Channon KM, Kharbanda RK, Banning AP. What are the causes of a suboptimal FFR after coronary stent deployment? Insights from a consecutive series using OCT imaging. EuroIntervention 2018;14:e1324-31

5.. Azzalini L, Poletti E, Demir OM, Ancona MB, Mangieri A, Giannini F, Carlino M, Chieffo A, Montorfano M, Colombo A, Latib A. Impact of Post-Percutaneous Coronary Intervention Fractional Flow Reserve Measurement on Procedural Management and Clinical Outcomes: The REPEAT-FFR Study. J Invasive Cardiol 2019;31:229-34

For those people who are too busy to click on the link .Summary of REPEAT-FFR study .