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Background  Fractional flow reserve ( FFR ) and coronary flow reserve ( CFR ) are well‐validated physiological indices; however, changes in  FFR  and  CFR  after percutaneous coronary intervention ( PCI ) remain elusive. We sought to evaluate these changes and to investigate whether physiological indices predict cardiac event‐free survival after  PCI .    Methods and Results  Physiological assessment of 220 stenoses from 220 patients was performed before and after  PCI . The changes in  FFR  and  CFR  were studied, and factors associated with  CFR  change were investigated. Follow‐up data were collected to determine the predictor of cardiac events.  CFR  increase was found in 158 (71.8%) territories, and 62 (28.2%) presented a decrease, whereas  FFR  increased in all 220 (100%) territories. Pre‐ and post‐ PCI  percentage diameter stenoses were 57.7±11.2% and 7.48±4.79%, respectively. Post‐ PCI CFR  increase was associated with pre‐ PCI  indices including low  FFR , low  CFR  and high microvascular resistance, and post‐ PCI  hyperemic coronary flow increase. Post‐ PCI CFR  decrease was not associated with significant post‐ PCI  hyperemic coronary flow increase. At a median follow‐up of 24.3 months, adverse event–free survival was significantly worse in patients with lower pre‐ PCI CFR  (log‐rank test λ 2 =7.26;  P =0.007). Cox proportional hazards analysis showed that lower pre‐ PCI CFR  (hazard ratio 0.73; 95%  CI  0.55–0.97;  P =0.028) was an independent predictor of adverse cardiovascular events after  PCI .    Conclusions   CFR  decrease after  PCI  was not uncommon, and discordant change in  FFR  and  CFR  was associated with high pre‐ PCI CFR , low pre‐ PCI  microvascular resistance, and no significant post‐ PCI  hyperemic coronary flow increase. Pre‐ PCI CFR , not post‐ PCI  physiological indices, may help identify patients who require adjunctive management strategy after successful  PCI .

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention