| 한정규¹ , 구본권¹ , 임홍석² , 윤명호² , 남창욱³ , 허승호³ , 도준형⁴ , 이성윤⁴ , 양한모¹ , 박경우¹ , 강현재¹ , 탁승제² , 김효수¹ |
Background: Although fractional flow reserve (FFR) has verified its role in determining the treatment strategy in de novo stenosis in coronary arteries, the role in in-stent restenosis (ISR) is still largely unexplored.
Methods: Up to now, 1994 consecutive patients were enrolled in Korean 4 center FFR registry from Mar, 2003 to Mar, 2011. Among those, the data from 102 patients (107 lesions) with ISR were divided into 2 groups based on FFR (≥0.8 vs <0.8), and analyzed (mean F/U duration: 37.1±26.1 months). Major adverse cardic events (MACE) were defined as all-cause mortality, myocardial infarction and target lesion revascularization (TLR).
Results: Baseline characteristics of the patients were not different between 2 groups in terms of age, sex, cardiovascular risk factors, clinical indication for index coronary angiography, and medication at discharge. Overall, FFR was not strongly correlated with minimum lumen diameter (r=0.27, p=0.01), %diameter stenosis (r=0.2, p=0.08), and lesion length (r=0.24, p=0.02) by quantitative coronary angiography. FFR≥0.8 group (mean FFR 0.89±0.05) showed bigger minimal luminal diameter (p=0.001) and less % diameter stenosis (p=0.004) than FFR<0.8 group (mean FFR 0.71±0.08). 62% of FFR<0.8 lesions underwent revascularization. Mean F/U duration was 38.2±25.8, and 35.3±26.8 months in FFR≥0.8, and <0.8 group, respectively. During F/U, 5 cases (11.9%) of MACE occurred in FFR<0.8 group, compared with 1 case (1.5%) in FFR≥0.8 group (p=0.023). In FFR<0.8 group, there were 2 cases (4.8%) of mortality and 3 cases (7.1%) of TLR. In FFR≥0.8 group, 1 case of TLR occured (Fig 1). In MACE-occured group, mean FFR was 0.73±0.07, which was lower than control group (mean FFR 0.82±0.11) (p=0.04) (Fig 2). MACE-and all-cause mortality free-survival was better in FFR≥0.8 group (p=0.02, 0.04, respectively) (Fig 3).
Conclusions: In ISR lesions, correlation between angiographic parameter and FFR was weak. ISR lesions with FFR<0.8 was associated with more frequent adverse events in spite of lower deferral rate.
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