Usefulness of the trans‐stent fractional flow reserve gradient for predicting clinical outcomes

Abstract Objectives We evaluated the usefulness of a fractional flow reserve (FFR) gradient across the stent (ΔFFR stent ) for long‐term clinical outcomes after percutaneous coronary intervention (PCI) with a drug‐eluting stent (DES). Background The clinical meaning of a trans‐stent pressure gradient after DES implantation has not been estimated adequately. Methods FFR pull‐back and intravascular ultrasound (IVUS) were performed after successful PCI in 135 left anterior descending artery lesions. ΔFFR stent was defined as the FFR gradient across the stent. The ΔFFR stent/length was defined as the ΔFFR stent value divided by the total stent length multiplied by 10. Major adverse cardiac events (MACEs) were the composite of all‐cause death, target vessel‐related myocardial infarction, and target lesion revascularization. Results Despite successful PCI, ΔFFR stent > 0 was observed in 98.5% of cases. ΔFFR stent ≥ 0.04 and ΔFFR stent/length ≥ 0.009 predicted suboptimal stenting defined as final minimal stent area < 5.5 mm 2 . During 2,183 ± 898 days, the MACE‐free survival rate was significantly lower in patients with ΔFFR stent ≥ 0.04 and ΔFFR stent/length ≥ 0.009 compared to those with lower values (69.6 vs. 93.4%, log‐rank p = .031; 72.1 vs. 97.7%, log‐rank p = .003, respectively). ΔFFR stent/length ≥ 0.009 (hazard ratio 10.1, p = .032) was an independent predictor of MACE. Conclusion A trans‐stent FFR gradient was frequently observed. ΔFFR stent and ΔFFR stent/length are related to long‐term outcomes in DES‐treated patients.