PCI & AimRadial 2018 | Post-PCI FFR: Time is coming - Olivier F. Bertrand

1. Post-PCI FFR: Time is coming
Olivier F. Bertrand, MD, PhD
Associate-Professor of Medicine, Laval University
Adjunct-Professor, Department of Mechanical Engineering, McGill University
Quebec Heart-Lung Institute
3d PCI Workshop, Sarasota, Fl
Nov 30, 2018

2. DISCLOSURES
• Consultant, Opsens
• President and Co-founder, Nanostent
• Scientific Director of International Chair in Interventional
Cardiology and Transradial Approach (Laval University, Qc)
• operates www.theradialist.org
• organizes PCI Worskhop & AIM-RADIAL congress (www.pci-
aimradial.com)
• Chair receives funding from multiple industry and other
sources

3. CAUDAL RAO VIEW

4. CRANIAL RAO VIEW

5. LATERAL VIEW

6. FFR IN LAD ARTERY
Pd/Pa = 0.68
FFR = 0.47
Pd/Pa = 0.68
FFR = 0.47

7. BALLOON 2.0MM

8. POST-BALLOON 1
Pd/Pa = 0.88
FFR = 0.72
Pd/Pa = 0.88
FFR = 0.72

9. BALLOON 3.0 MM
Pd/Pa = 0.92
FFR = 0.82
Pd/Pa = 0.92
FFR = 0.82

10. STENT IMPLANTATION

11. POST-STENT 1

12. POST-STENT 2
Pd/Pa = 0.92
FFR = 0.84
Pd/Pa = 0.92
FFR = 0.84

13. POST-STENT 2

14. POST-PCI FFR DISTRIBUTION
Rimac et al. Am Heart J 2017;183:1-9

15. CUMULATIVE INCIDENCE
0.90 +- 0.04
Rimac et al. Am Heart J 2017;183:1-9

16. RELATIONSHIP WITH RE-PCI
Post-PCI FFR >= 0.90
OR (95% CI): 0.43 (0.34-0.56)
Rimac et al. Am Heart J 2017;183:1-9

17. RELATIONSHIP WITH MACE
Post-PCI FFR >= 0.90
OR (95% CI): 0.71 (059-0.85)
Rimac et al. Am Heart J 2017;183:1-9

18. PATIENT DATA
Johnson N. et al. JACC Intv 2014;64: 1641-54

19. INTERNATIONAL
REGISTRY
Hwang et al. 2018 (in press)

20. FOCAL VS DIFFUSE
Rimac et al. Am Heart J 2017;183:1-9

21. ABSORB II: ANGINA
Serruys P et al. Lancet 2016;388:2479-2491

22. ABSORB II: ANGINA

23. • Measure Final FFR after successful PCI (30% DS/TIMI
3)
• All-comers (no exclusion criteria)
• Clinical follow-up (TVF) at 30 days, 6M, 1Y and 2Y
• Angina score (EQ-5, Seattle angina)
• Costs (consumables and hospitalisation costs)
Physiology Randomized Study Evaluating the Direct Impact
of Coronary Lesion Treatment: the PREDICT Randomized Study

24. • End-points
• Final FFR
• dPR, Pd/Pa
• TVF (Death, MI, TVR) (PRIMARY): 24 M
• Angina score
• Cost-effectiveness
Physiology Randomized Study Evaluating the Direct Impact of
Coronary Lesion Treatment: the PREDICT Randomized Study

25. SAMPLE SIZES ESTIMATES

27. CONCLUSION
• Optical fiber technology allowed to develop
improved PCI-like floppy wire with exceptional
pressure stability and much improved connectivity
• Since physiology assessment is now well
established as reference tool to decide upon
intervention, it is time to assess whether post-PCI
FFR measurement might guide PCI strategy and
completion