Open AccessPost-stenting fractional flow reserve vs coronary angiography for optimization of percutaneous coronary intervention (TARGET-FFR)
Author(s) -
Damien Collison,
Matthaios Didagelos,
Muhammad Aetesam-ur-Rahman,
Samuel Copt,
Robert McDade,
Peter McCartney,
Tom Ford,
John McClure,
Mitchell Lindsay,
Aadil Shaukat,
Paul Rocchiccioli,
Richard Brogan,
Stuart Watkins,
Margaret McEntegart,
Richard Good,
Keith Robertson,
Patrick O’Boyle,
Andrew Davie,
Adnan Khan,
Stuart Hood,
Hany Eteiba,
Colin Berry,
Keith G. Oldroyd
Publication year - 2021
Publication title -
european heart journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.336
H-Index - 293
eISSN - 1522-9645
pISSN - 0195-668X
DOI - 10.1093/eurheartj/ehab449
Subject(s) - medicine , conventional pci , fractional flow reserve , percutaneous coronary intervention , cardiology , confidence interval , clinical endpoint , randomized controlled trial , stent , angiography , coronary angiography , myocardial infarction
Aims A fractional flow reserve (FFR) value ≥0.90 after percutaneous coronary intervention (PCI) is associated with a reduced risk of adverse cardiovascular events. TARGET-FFR is an investigator-initiated, single-centre, randomized controlled trial to determine the feasibility and efficacy of a post-PCI FFR-guided optimization strategy vs. standard coronary angiography in achieving final post-PCI FFR values ≥0.90. Methods and results After angiographically guided PCI, patients were randomized 1:1 to receive a physiology-guided incremental optimization strategy (PIOS) or a blinded coronary physiology assessment (control group). The primary outcome was the proportion of patients with a final post-PCI FFR ≥0.90. Final FFR ≤0.80 was a prioritized secondary outcome. A total of 260 patients were randomized (131 to PIOS, 129 to control) and 68.1% of patients had an initial post-PCI FFR <0.90. In the PIOS group, 30.5% underwent further intervention (stent post-dilation and/or additional stenting). There was no significant difference in the primary endpoint of the proportion of patients with final post-PCI FFR ≥0.90 between groups (PIOS minus control 10%, 95% confidence interval −1.84 to 21.91, P = 0.099). The proportion of patients with a final FFR ≤0.80 was significantly reduced when compared with the angiography-guided control group (−11.2%, 95% confidence interval −21.87 to −0.35], P = 0.045). Conclusion Over two-thirds of patients had a physiologically suboptimal result after angiography-guided PCI. An FFR-guided optimization strategy did not significantly increase the proportion of patients with a final FFR ≥0.90, but did reduce the proportion of patients with a final FFR ≤0.80.