Prognostic value of poststenting fractional flow reserve (FFR) remains uncertain in patients undergoing an imaging-guided optimal stenting strategy. The authors evaluated the prognostic value of poststenting FFR according to the intracoronary imaging-guided lesion preparation, stent sizing, and postdilation (iPSP) strategy to optimize stent outcomes. Poststenting FFR assessment was performed in 1,108 lesions in 1,005 patients from the IRIS-FFR registry. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization at 5 years. At the index procedure, 326 lesions (29.4%) were treated using all 3 parts of the iPSP strategy. In the overall population, poststenting FFR was significantly associated with the risk of TVF at 5 years (per 0.01 increase of FFR, adjusted HR [aHR]: 0.94; 95% CI: 0.90-0.98; = 0.004). Significant interaction was detected between poststenting FFR and the iPSP strategy on the risk of TVF at 5 years ( = 0.045 for interaction). In the iPSP group, poststenting FFR was not associated with the risk of TVF at 5 years (per 0.01 increase of FFR, aHR: 1.00; 95% CI: 0.96-1.05; = 0.95), whereas a significant association between poststenting FFR and TVF at 5 years was observed in the no iPSP group (per 0.01 increase of FFR, aHR: 0.94; 95% CI: 0.90-0.99; = 0.009). Poststenting FFR showed a significant association with cardiac events. However, its prognostic value appeared to be limited after the application of an imaging-guided optimal stenting strategy.

中文翻译：

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影像引导最佳支架置入术后支架后血流储备分数的预后价值

对于接受影像引导最佳支架置入策略的患者，支架置入后血流储备分数 (FFR) 的预后价值仍不确定。作者根据冠状动脉内成像引导的病变准备、支架尺寸和后扩张 (iPSP) 策略评估了支架置入后 FFR 的预后价值，以优化支架结果。对 IRIS-FFR 登记处的 1,005 名患者的 1,108 个病变进行了支架植入后 FFR 评估。主要结局是靶血管衰竭（TVF），这是 5 年心源性死亡、靶血管心肌梗死和靶血管血运重建的复合结果。在索引手术中，使用 iPSP 策略的所有 3 个部分治疗了 326 个病变 (29.4%)。在总体人群中，支架术后 FFR 与 5 年时 TVF 风险显着相关（FFR 每增加 0.01，调整后 HR [aHR]：0.94；95% CI：0.90-0.98；= 0.004）。在支架置入后 FFR 和 iPSP 策略之间检测到 5 年 TVF 风险存在显着的交互作用（交互作用 = 0.045）。在 iPSP 组中，支架术后 FFR 与 5 年时 TVF 风险无关（FFR 每增加 0.01，aHR：1.00；95% CI：0.96-1.05；= 0.95），而支架后 FFR 与 TVF 之间存在显着相关性在无 iPSP 组中观察到 5 年时的情况（FFR 每增加 0.01，aHR：0.94；95% CI：0.90-0.99；= 0.009）。支架置入后 FFR 与心脏事件显着相关。然而，在应用影像引导的最佳支架置入策略后，其预后价值似乎受到限制。