Outcomes from the randomized managed TARGET FFR trial present that whereas a physiology-guided percutaneous coronary intervention (PCI) optimization technique didn’t obtain a big enhance within the proportion of sufferers with closing FFR ≥0.90, it lowered the proportion of sufferers with a residual FFR ≤0.80 following PCI.
Findings had been reported immediately at TCT Join, the thirty second annual scientific symposium of the Cardiovascular Analysis Basis (CRF).
260 sufferers had been efficiently randomized between March 2018 and November 2019 at a single web site. Following angiographically profitable PCI procedures, sufferers had been randomized (1:1) to obtain both a physiology-guided incremental optimization technique (PIOS intervention group, n=131) or blinded post-PCI coronary physiology measurements (control group, n=129). Sufferers present process profitable, standard-of-care PCI for both secure angina or medically stabilized non-ST-segment-elevation myocardial infarction (NSTEMI) had been eligible for randomization.
The trial’s major endpoint was outlined because the proportion of sufferers with a closing post-PCI FFR consequence ≥0.90. The examine discovered that the incidence of ultimate FFR ≥0.90 was 10% larger within the PIOS group than the management group however that the distinction was not statistically important (38.1% vs. 28.1%, p=0.099). Nonetheless, the examine’s secondary endpoint, the proportion of sufferers with closing FFR ≤0.80, was considerably decrease within the PIOS group (18.6% vs 29.8%, p=0.045).
Primarily based on FFR pullback evaluation of the stented vessel, a goal for additional optimization was current in 60 of the 131 (46%) sufferers randomized to PIOS, and operators thought of it applicable to carry out extra post-dilatation +/- stenting in 40 of those 60 (66%) sufferers. Amongst sufferers who had additional intervention/optimization carried out, imply post-PCI FFR elevated considerably from 0.76 to 0.82 (p<.001 and="" mean="" coronary="" flow="" reserve="" increased="" from="" to="" wp_automatic_readability="15.610456553756">
“When assessing the proposed optimum post-PCI FFR cutoff worth of ≥0.90, we discovered that almost all of sufferers with angiographically acceptable PCI outcomes even have a physiologically suboptimal final result,” stated Damien Collison, MD, Interventional Heart specialist on the Golden Jubilee Nationwide Hospital, Glasgow, Scotland. “As much as 30% of sufferers might actually have a closing FFR consequence that is still beneath the guideline-directed threshold for performing revascularization within the first place. In our randomized managed trial, utility of an FFR-guided optimization technique after stenting led to enhancements in each FFR and CFR and considerably lowered the proportion of sufferers with a closing post-PCI FFR ≤0.80.
Cardiovascular Research Foundation
Physiology-guided percutaneous coronary intervention optimization technique might result in improved outcomes (2020, October 17)
retrieved 17 October 2020
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