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)

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, Professor 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 > School of Cardiovascular & Metabolic Health; 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

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
303944		BHF Centre of Excellence	Rhian Touyz	British Heart Foundation (BHF)	RE/18/6/34217	CAMS - Cardiovascular Science