Pre‐stenting angiography‐FFR based physiological map provides virtual intervention and predicts physiological and clinical outcomes

Abstract

AbstractBackgroundAngiography‐derived fractional flow reserve (FFR) (angio‐FFR) has been validated against FFR and could provide virtual pullback. However, whether a physiological map can be generated by angio‐FFR and its clinical value remains unclear. We aimed to investigate the feasibility of physiological map created from angio‐FFR pullback and its value in predicting physiological and clinical outcomes after stenting.MethodsAn angio‐FFR physiological map was generated by overlaying the virtual pullback onto coronary angiogram, to calculate physiological stenosis severity, length, and intensity (Δangio‐FFR/mm). This map in combination with virtual stenting was used to predict the best‐case post‐percutaneous coronary intervention (PCI) angio‐FFR (angio‐FFRpredicted) according to the stented segments, and this was compared with the actual achieved post‐PCI angio‐FFR (angio‐FFRachieved). Additionally, prognostic value of predicted angio‐FFR was investigated.ResultsThree hundred twenty‐nine vessels with paired analyzable pre‐ and post‐PCI angio‐FFR were included. Physiological map was created successfully in all vessels. After successful PCI, angio‐FFRpredicted and angio‐FFRachieved were significantly correlated (r = 0.82, p < 0.001) with small difference (mean difference: −0.010 ± 0.035). In the virtual PCI only covering the segment with high angio‐FFR intensity, the same physiological outcome can be achieved with shorter stent length (14.1 ± 8.9 vs. 34.5 ± 15.8 mm, p < 0.001). Suboptimal angio‐FFRpredicted was associated with increased risk of 2‐year vessel‐oriented composite endpoint (adjusted hazard ratio: 3.71; 95% confidence interval: 1.50−9.17).ConclusionsAngio‐FFR pullback could provide a physiological map of the interrogated coronary vessels by integrating angio‐FFR pullback and angiography. Before a PCI, the physiological map can predict the physiological and clinical outcomes after stenting.