Post-stenting fractional flow reserve vs coronary angiography for optimization of percutaneous coronary intervention (TARGET-FFR)

Collison, D. et al. (2021) Post-stenting fractional flow reserve vs coronary angiography for optimization of percutaneous coronary intervention (TARGET-FFR). European Heart Journal, 42(45), pp. 4656-4668. (doi: 10.1093/eurheartj/ehab449) (PMID:34279606)

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Abstract

Aims: A fractional flow reserve (FFR) value ≥0.90 after percutaneous coronary intervention (PCI) is associated with a reduced risk of adverse cardiovascular events. TARGET-FFR is an investigator-initiated, single-centre, randomized controlled trial to determine the feasibility and efficacy of a post-PCI FFR-guided optimization strategy vs. standard coronary angiography in achieving final post-PCI FFR values ≥0.90. Methods and results: After angiographically guided PCI, patients were randomized 1:1 to receive a physiology-guided incremental optimization strategy (PIOS) or a blinded coronary physiology assessment (control group). The primary outcome was the proportion of patients with a final post-PCI FFR ≥0.90. Final FFR ≤0.80 was a prioritized secondary outcome. A total of 260 patients were randomized (131 to PIOS, 129 to control) and 68.1% of patients had an initial post-PCI FFR <0.90. In the PIOS group, 30.5% underwent further intervention (stent post-dilation and/or additional stenting). There was no significant difference in the primary endpoint of the proportion of patients with final post-PCI FFR ≥0.90 between groups (PIOS minus control 10%, 95% confidence interval −1.84 to 21.91, P = 0.099). The proportion of patients with a final FFR ≤0.80 was significantly reduced when compared with the angiography-guided control group (−11.2%, 95% confidence interval −21.87 to −0.35], P = 0.045). Conclusion: Over two-thirds of patients had a physiologically suboptimal result after angiography-guided PCI. An FFR-guided optimization strategy did not significantly increase the proportion of patients with a final FFR ≥0.90, but did reduce the proportion of patients with a final FFR ≤0.80.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McCartney, Dr Peter and Hood, Dr Stuart and Eteiba, Dr Hany and Aetesam-Ur-Rahman, Dr Muhammad and McClure, Dr John and Robertson, Dr Keith and McEntegart, Dr Margaret and Shaukat, Dr Aadil and Ford, Thomas and Collison, Dr Damien and Oldroyd, Dr Keith and Watkins, Dr Stuart and Berry, Professor Colin
Authors: Collison, D., Didagelos, M., Aetesam-Ur-Rahman, M., Copt, S., McDade, R., McCartney, P., Ford, T. J., McClure, J., Lindsay, M., Shaukat, A., Rocchiccioli, P., Brogan, R., Watkins, S., McEntegart, M., Good, R., Robertson, K., O’Boyle, P., Davie, A., Khan, A., Hood, S., Eteiba, H., Berry, C., and Oldroyd, K. G.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN:0195-668X
ISSN (Online):1522-9645
Published Online:19 July 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in European Heart Journal 42(45): 4656-4668
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science