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Original article
Clinical and prognostic value of poststenting fractional flow reserve in acute coronary syndromes
  1. Srikanth Kasula1,
  2. Shiv Kumar Agarwal1,
  3. Yalcin Hacioglu1,
  4. Nagavenkata Krishnachand Pothineni1,
  5. Sabha Bhatti1,
  6. Zubair Ahmed1,2,
  7. Barry Uretsky1,2,
  8. Abdul Hakeem1,2
  1. 1Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  2. 2Cardiology Section, Central Arkansas Veterans Affair Health System, Little Rock, Arkansas, USA
  1. Correspondence to Dr Abdul Hakeem, Central Arkansas VA Health System and Department of Cardiovascular Medicine, Slot # S3/05, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock AR 72205, USA; ahakeem{at}


Objectives Fractional flow reserve (FFR) has been suggested to have value in acute coronary syndromes (ACSs). The clinical and prognostic value of ischaemia reduction assessed by post-percutaneous coronary intervention (PCI) FFR has not been studied in this population.

Methods Consecutive stable ischaemic heart disease (SIHD) (N=390) and patients with ACS (N=189) who had pre-PCI FFR and post-PCI FFR were followed for 2.4±1.5 years. Primary endpoint was major adverse cardiac events (MACE) (composite of myocardial infarction, target vessel revascularisation and death).

Results In patients with ACS, PCI led to significant improvement in FFR from 0.62±0.15 to post-PCI FFR 0.88±0.08 (p<0.0001). Post-PCI FFR identified 29 patients (15%) who had persistently low FFR<0.80 (0.75±0.06) despite angiographically optimal results prompting subsequent interventions improving repeat FFR (0.85±0.06; p<0.0001). The difference in MACE events between patients with ACS and patients with SIHD varied according to the post-PCI FFR value (interaction p=0.044). Receiver operator curve analysis identified a final FFR cut-off of ≤0.91 as having the best predictive accuracy for MACE in the ACS study population (30% vs 19%; p=0.03). Patients with ACS achieving final FFR of >0.91 had similar outcomes compared with patients who had SIHD (19% vs 16%; p=0.51). However, in patients with final FFR of ≤0.91 there was increased MACE versus patients with SIHD (30% vs 16%; p<0.01).

Conclusions Post-PCI FFR is valuable in assessing the functional outcome of PCI in patients with ACS. Use of post-PCI FFR in patients with ACS allows for functional optimisation of PCI results and is predictive of long-term outcomes in patients with ACS.

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  • Contributors SK: acquisition, analysis and interpretation of data, drafting of manuscript. SKA, YH and NKP: data acquisition and critical revision of manuscript. SB, ZA and BU: interpretation of data and critical revision of manuscript. AH: study concept and design, acquisition analysis and interpretation of data and drafting and critical revision of manuscript. SK and AH: responsible for the overall content as guarantors.

  • Competing interests None declared.

  • Ethics approval Central Arkansas VA Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.