Trial of Angiography versus pressure-Ratio Guided Enhancement Techniques - Fractional Flow Reserve - TARGET FFR

Contribution To Literature:

The TARGET FFR trial failed to show that a physiology-guided incremental optimization strategy was beneficial at improving the proportion of physiologically optimal PCI.

Description:

The goal of the trial was to evaluate a physiology-guided incremental optimization strategy compared with usual care among patients who underwent angiographically successful percutaneous coronary intervention (PCI).

Study Design

  • Randomized
  • Parallel
  • Blinded

After successful PCI, subjects underwent FFR of the target lesion. Subjects were randomized to a physiology-guided incremental optimization strategy versus a blinded control group. In the physiology-guided incremental optimization arm, PCI could be further optimized (post-dilatation) according to suboptimal FFR values.

  • Total number of enrollees: 260
  • Duration of follow-up: 1 year
  • Mean patient age: 59 years
  • Percentage female: 13%
  • Percentage with diabetes: 19%

Inclusion criteria:

  • Subjects who underwent angiographically successful PCI

Other salient features/characteristics:

Post-PCI (pre-randomization), the FFR value was ≥0.9 in 32%, 0.81-0.89 in 39%, and ≤0.8 in 29%.

Principal Findings:

The primary outcome, proportion of patients with FFR ≥0.9, was 38.1% in the physiology-guided incremental optimization group compared with 28.1% in the blinded control group (p = 0.099).

Secondary outcomes: The proportion of patients with FFR ≤0.8 was 18.6% in the physiology-guided incremental optimization group compared with 29.8% in the blinded control group (p = 0.045).

Interpretation:

Among patients who underwent angiographically successful PCI, a physiology-guided incremental optimization strategy failed to improve the proportion of patients with an optimal result (i.e., FFR ≥0.9). A physiology-guided incremental optimization strategy was associated with a marginal decrease in suboptimal result (i.e., FFR ≤0.8).

References:

Presented by Dr. Damien Collison at the Transcatheter Cardiovascular Therapeutics Virtual Meeting (TCT Connect), October 16, 2020.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Angiography, Coronary Angiography, Dilatation, Fractional Flow Reserve, Myocardial, Myocardial Ischemia, Percutaneous Coronary Intervention, Physiology, TCT20, Transcatheter Cardiovascular Therapeutics


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