Usefulness of coronary pressure measurement for functional evaluation of drug-eluting stent restenosis

Chang Wook Nam, Seung Woon Rha, Bonkwon Koo, Joon Hyung Doh, Woo-Young Chung, Myeong Ho Yoon, Seung Jea Tahk, Bong Ki Lee, Jin Bae Lee, Ki Dong Yoo, Yun Kyeong Cho, In Sung Chung, Seung Ho Hur, Kwon Bae Kim, Cheol Ung Choi, Dong Joo Oh

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Abstract

Despite the widespread adoption of drug-eluting stent (DES) implantation, the optimal treatment of DES failures remains challenging. The present study evaluated the relation between quantitative angiography and the fractional flow reserve (FFR) in restenotic lesions after DES implantation and the efficacy of FFR in determining whether to treat these lesions. To assess their functional significance, the coronary pressure-derived FFR was measured in 50 DES restenotic lesions (49 patients). Additional intervention was performed in lesions with a FFR <0.8. Major adverse cardiac events were assessed at 12 months after the reintervention procedure. The mean percent diameter stenosis (%DS) was 58 ± 13%. Of the 50 lesions, 20 (40%) were deferred without additional intervention. The FFR and %DS had a negative correlation (r = -0.61, p <0.001). However, when only the lesions with diffuse-type restenosis (15 lesions) were analyzed, the degree of correlation decreased (r = -0.56, p = 0.12). Although most lesions (89%) with a %DS of <70 had significant functional ischemia, among 41 lesions with a %DS <70, only 20 (49%) had demonstrated functional patency. The incidence of adverse events during the 12 months of follow-up after FFR-guided treatment was 18.0% (23.3% in the FFR <0.80 group and 10.0% in FFR <0.80 group). In conclusion, a discrepancy was found between functional ischemia measured by the FFR and the angiographic %DS, in particular, in moderate- or diffuse-type restenotic lesions after DES implantation. The outcome of FFR-guided deferral in patients with DES in-stent restenosis seems favorable.

Original languageEnglish
Pages (from-to)1783-1786
Number of pages4
JournalAmerican Journal of Cardiology
Volume107
Issue number12
DOIs
StatePublished - 15 Jun 2011

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Drug-Eluting Stents
Pressure
Ischemia
Stents
Angiography
Pathologic Constriction
Incidence
Therapeutics

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Nam, Chang Wook ; Rha, Seung Woon ; Koo, Bonkwon ; Doh, Joon Hyung ; Chung, Woo-Young ; Yoon, Myeong Ho ; Tahk, Seung Jea ; Lee, Bong Ki ; Lee, Jin Bae ; Yoo, Ki Dong ; Cho, Yun Kyeong ; Chung, In Sung ; Hur, Seung Ho ; Kim, Kwon Bae ; Choi, Cheol Ung ; Oh, Dong Joo. / Usefulness of coronary pressure measurement for functional evaluation of drug-eluting stent restenosis. In: American Journal of Cardiology. 2011 ; Vol. 107, No. 12. pp. 1783-1786.
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title = "Usefulness of coronary pressure measurement for functional evaluation of drug-eluting stent restenosis",
abstract = "Despite the widespread adoption of drug-eluting stent (DES) implantation, the optimal treatment of DES failures remains challenging. The present study evaluated the relation between quantitative angiography and the fractional flow reserve (FFR) in restenotic lesions after DES implantation and the efficacy of FFR in determining whether to treat these lesions. To assess their functional significance, the coronary pressure-derived FFR was measured in 50 DES restenotic lesions (49 patients). Additional intervention was performed in lesions with a FFR <0.8. Major adverse cardiac events were assessed at 12 months after the reintervention procedure. The mean percent diameter stenosis ({\%}DS) was 58 ± 13{\%}. Of the 50 lesions, 20 (40{\%}) were deferred without additional intervention. The FFR and {\%}DS had a negative correlation (r = -0.61, p <0.001). However, when only the lesions with diffuse-type restenosis (15 lesions) were analyzed, the degree of correlation decreased (r = -0.56, p = 0.12). Although most lesions (89{\%}) with a {\%}DS of <70 had significant functional ischemia, among 41 lesions with a {\%}DS <70, only 20 (49{\%}) had demonstrated functional patency. The incidence of adverse events during the 12 months of follow-up after FFR-guided treatment was 18.0{\%} (23.3{\%} in the FFR <0.80 group and 10.0{\%} in FFR <0.80 group). In conclusion, a discrepancy was found between functional ischemia measured by the FFR and the angiographic {\%}DS, in particular, in moderate- or diffuse-type restenotic lesions after DES implantation. The outcome of FFR-guided deferral in patients with DES in-stent restenosis seems favorable.",
author = "Nam, {Chang Wook} and Rha, {Seung Woon} and Bonkwon Koo and Doh, {Joon Hyung} and Woo-Young Chung and Yoon, {Myeong Ho} and Tahk, {Seung Jea} and Lee, {Bong Ki} and Lee, {Jin Bae} and Yoo, {Ki Dong} and Cho, {Yun Kyeong} and Chung, {In Sung} and Hur, {Seung Ho} and Kim, {Kwon Bae} and Choi, {Cheol Ung} and Oh, {Dong Joo}",
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Nam, CW, Rha, SW, Koo, B, Doh, JH, Chung, W-Y, Yoon, MH, Tahk, SJ, Lee, BK, Lee, JB, Yoo, KD, Cho, YK, Chung, IS, Hur, SH, Kim, KB, Choi, CU & Oh, DJ 2011, 'Usefulness of coronary pressure measurement for functional evaluation of drug-eluting stent restenosis', American Journal of Cardiology, vol. 107, no. 12, pp. 1783-1786. https://doi.org/10.1016/j.amjcard.2011.02.328

Usefulness of coronary pressure measurement for functional evaluation of drug-eluting stent restenosis. / Nam, Chang Wook; Rha, Seung Woon; Koo, Bonkwon; Doh, Joon Hyung; Chung, Woo-Young; Yoon, Myeong Ho; Tahk, Seung Jea; Lee, Bong Ki; Lee, Jin Bae; Yoo, Ki Dong; Cho, Yun Kyeong; Chung, In Sung; Hur, Seung Ho; Kim, Kwon Bae; Choi, Cheol Ung; Oh, Dong Joo.

In: American Journal of Cardiology, Vol. 107, No. 12, 15.06.2011, p. 1783-1786.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Usefulness of coronary pressure measurement for functional evaluation of drug-eluting stent restenosis

AU - Nam, Chang Wook

AU - Rha, Seung Woon

AU - Koo, Bonkwon

AU - Doh, Joon Hyung

AU - Chung, Woo-Young

AU - Yoon, Myeong Ho

AU - Tahk, Seung Jea

AU - Lee, Bong Ki

AU - Lee, Jin Bae

AU - Yoo, Ki Dong

AU - Cho, Yun Kyeong

AU - Chung, In Sung

AU - Hur, Seung Ho

AU - Kim, Kwon Bae

AU - Choi, Cheol Ung

AU - Oh, Dong Joo

PY - 2011/6/15

Y1 - 2011/6/15

N2 - Despite the widespread adoption of drug-eluting stent (DES) implantation, the optimal treatment of DES failures remains challenging. The present study evaluated the relation between quantitative angiography and the fractional flow reserve (FFR) in restenotic lesions after DES implantation and the efficacy of FFR in determining whether to treat these lesions. To assess their functional significance, the coronary pressure-derived FFR was measured in 50 DES restenotic lesions (49 patients). Additional intervention was performed in lesions with a FFR <0.8. Major adverse cardiac events were assessed at 12 months after the reintervention procedure. The mean percent diameter stenosis (%DS) was 58 ± 13%. Of the 50 lesions, 20 (40%) were deferred without additional intervention. The FFR and %DS had a negative correlation (r = -0.61, p <0.001). However, when only the lesions with diffuse-type restenosis (15 lesions) were analyzed, the degree of correlation decreased (r = -0.56, p = 0.12). Although most lesions (89%) with a %DS of <70 had significant functional ischemia, among 41 lesions with a %DS <70, only 20 (49%) had demonstrated functional patency. The incidence of adverse events during the 12 months of follow-up after FFR-guided treatment was 18.0% (23.3% in the FFR <0.80 group and 10.0% in FFR <0.80 group). In conclusion, a discrepancy was found between functional ischemia measured by the FFR and the angiographic %DS, in particular, in moderate- or diffuse-type restenotic lesions after DES implantation. The outcome of FFR-guided deferral in patients with DES in-stent restenosis seems favorable.

AB - Despite the widespread adoption of drug-eluting stent (DES) implantation, the optimal treatment of DES failures remains challenging. The present study evaluated the relation between quantitative angiography and the fractional flow reserve (FFR) in restenotic lesions after DES implantation and the efficacy of FFR in determining whether to treat these lesions. To assess their functional significance, the coronary pressure-derived FFR was measured in 50 DES restenotic lesions (49 patients). Additional intervention was performed in lesions with a FFR <0.8. Major adverse cardiac events were assessed at 12 months after the reintervention procedure. The mean percent diameter stenosis (%DS) was 58 ± 13%. Of the 50 lesions, 20 (40%) were deferred without additional intervention. The FFR and %DS had a negative correlation (r = -0.61, p <0.001). However, when only the lesions with diffuse-type restenosis (15 lesions) were analyzed, the degree of correlation decreased (r = -0.56, p = 0.12). Although most lesions (89%) with a %DS of <70 had significant functional ischemia, among 41 lesions with a %DS <70, only 20 (49%) had demonstrated functional patency. The incidence of adverse events during the 12 months of follow-up after FFR-guided treatment was 18.0% (23.3% in the FFR <0.80 group and 10.0% in FFR <0.80 group). In conclusion, a discrepancy was found between functional ischemia measured by the FFR and the angiographic %DS, in particular, in moderate- or diffuse-type restenotic lesions after DES implantation. The outcome of FFR-guided deferral in patients with DES in-stent restenosis seems favorable.

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JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

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