Physiology-guided PCI Optimization Strategy Evaluated in TARGET FFR Study

October 16, 2020—Results from the randomized controlled TARGET FFR trial showed that while a physiology-guided percutaneous coronary intervention (PCI) optimization strategy did not achieve a significant increase in the proportion of patients with final FFR ≥ 0.9, it reduced the proportion of patients with a residual FFR ≤ 0.8 after PCI.

The findings were presented by Damien Collison, MD, at TCT Connect, the 32nd annual Transcatheter Cardiovascular Therapeutics scientific symposium of the Cardiovascular Research Foundation held online October 14-18, 2020.

As summarized by TCT Connect, TARGET FFR enrolled 260 patients between March 2018 and November 2019 at a single site. After angiographically successful PCI procedures, patients were randomized (1:1) to receive either a physiology-guided incremental optimization strategy (PIOS intervention group, n = 131) or blinded post-PCI coronary physiology measurements (control group, n = 129). Patients undergoing successful, standard-of-care PCI for either stable angina or medically stabilized non-ST-segment-elevation myocardial infarction were eligible for randomization.

The trial’s primary endpoint was defined as the proportion of patients with a final post-PCI FFR result ≥ 0.9. The study found that the incidence of final FFR ≥ 0.9 was 10% higher in the PIOS group than the control group but that the difference was not statistically significant (38.1% vs 28.1%; P = .099). However, the study’s secondary endpoint, the proportion of patients with final FFR ≤ 0.8, was significantly lower in the PIOS group (18.6% vs 29.8%; P = .045).

Based on FFR pullback assessment of the stented vessel, a target for further optimization was present in 60 of the 131 (46%) patients randomized to PIOS, and operators considered it appropriate to perform additional postdilatation with or without stenting in 40 of these 60 (66%) patients.

Among patients who had further intervention/optimization performed, mean post-PCI FFR increased significantly from 0.76 to 0.82 (P < .001) and mean coronary flow reserve (CFR) increased from 3.0 to 4.0 (P = .02).

“When assessing the proposed optimal post-PCI FFR cutoff value of ≥ 0.9, we found that the majority of patients with angiographically acceptable PCI results actually have a physiologically suboptimal outcome,” commented Dr. Collison in the TCT Connect announcement. “Up to 30% of patients may even have a final FFR result that remains below the guideline-directed threshold for performing revascularization in the first place. In our randomized controlled trial, application of an FFR-guided optimization strategy after stenting led to improvements in both FFR and CFR and significantly reduced the proportion of patients with a final post-PCI FFR ≤ 0.8.”