Comparison Optimal Value of the Fractional Flow Reserve and Anatomic Values Assessed by Intravascular Ultrasound in Diffuse Lesion after Drug-Eluting Stent Deployment.

초록

Background: Little is known regarding functional value of the fractional flow reserve (FFR) criteria to determine successful results after percutaneous coronary intervention with drug-eluting stent (DES) in diffuse long lesion of the coronary artery. This study compared the functional value of the FFR criteria to anatomically successful result criteria assessed by intravascular ultrasound (IVUS) with DES deployment in diffuse lesions of the coronary artery. Methods: Sixty-four patients and 71 lesions with diffuse long coronary artery disease (30 mm) were enrolled. After DES deployment, we assessed the minimal stent area (MSA), area stenosis (AS) by IVUS, and FFR by intracoronary pressure wire. The FFR was defined as the ratio of mean distal coronary pressure of the lesion and the proximal coronary pressure during hyperemia induced by intracoronary bolus injection of adenosine (left coronary artery: 48–80 g, right coronary artery: 36–60 g). Results: The MSA after stent deployment showed a positive correlation with the FFR value (r 0.472, p 0.001) and AS revealed a significant inverse correlation with the value of FFR (r – 0.439, p 0.001). By receiver operating characteristics curve analysis, the best cutoff value of MSA for 0.94 of FFR value was 6.4 cm2 (area under the curve [AUC]: 0.775, sensitivity: 77.8%, specificity: 72.7%). The best cutoff value of FFR for 5.0 mm2 and 5.5 mm2 of MLA by IVUS was 0.92 (AUC: 0.774, sensitivity: 80.0%, specificity: 66.7%) and 0.93 (AUC: 0.779, sensitivity: 75.0%, specificity: 71.4%). Conclusion: Although the FFR value after DES deployment showed a significant correlation with the anatomic parameters obtained by IVUS, physiologic value of the FFR criteria for successful DES deployment was lower than previous results, and further study about the optimal physiologic value of the FFR criteria may be required in diffuse long lesion after DES stent deployment.