Physiology-guided optimisation of percutaneous coronary intervention

Collison, Damien Gerard (2023) Physiology-guided optimisation of percutaneous coronary intervention. MD thesis, University of Glasgow.

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 was an investigator-initiated, single centre, randomised controlled trial to determine the feasibility and efficacy of a post-PCI FFRguided optimisation strategy versus standard coronary angiography in achieving final post-PCI FFR values ≥ 0.90.

Methods and Results

After angiographically-guided PCI, patients were randomised 1:1 to receive a Physiology-guided Incremental Optimisation 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 prioritised secondary outcome. 260 patients were randomised (131 to PIOS, 129 to control). 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% CI -1.84 to 21.91, p=0.099). The proportion of patients with a final FFR ≤ 0.80 was significantly reduced when compared to the angiography-guided control group (-11.2%, 95% CI -21.87 to -0.35, p=0.045).

Conclusion

Over two-thirds of patients had a physiologically suboptimal result after angiographically guided PCI. A post-PCI FFR-guided optimisation 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. Larger increases in FFR following PCI were associated with greater improvements in patient-reported angina and quality-of-life.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Subjects: R Medicine > R Medicine (General)
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Supervisor's Name: Berry, Professor Colin and Oldroyd, Professor Keith
• Date of Award: 2023
• Depositing User: Theses Team
• Unique ID: glathesis:2023-83506
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 28 Mar 2023 09:57
• Last Modified: 24 Nov 2023 10:14
• Thesis DOI: 10.5525/gla.thesis.83506
• URI: https://theses.gla.ac.uk/id/eprint/83506

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