Key measurements taken immediately after coronary stent implantation can predict patient outcomes for years to come, according to a new study published in JACC: Cardiovascular Interventions. Researchers identified a lower level of post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR), a measure of blood flow through the artery, as indicative of a significantly higher rate of target vessel failure (TVF), including cardiac death, heart attack and repeat procedures to reopen the artery. “The risk for TVF was higher in the low post-PCI FFR group than in the high post-PCI FFR group at 5 years (adjusted HR [aHR]: 1.95; 95% confidence interval [CI]: 1.46-2.62; P<0.001),” said the paper’s authors, led by Doyeon Hwang, MD, of the Seoul National University Hospital, South Korea. “The higher risk for TVF in the low post-PCI FFR group compared with the high post-PCI FFR group was prominent within 3 years after PCI (aHR: 2.00; 95% CI: 1.44-2.78; P<0.001) and attenuated 3 years after PCI (aHR: 1.80; 95% CI: 0.94-3.44; P = 0.076).” Study approach The research followed more than 2,100 patients across Korea, Japan and China for five years after receiving drug-eluting stents. Findings revealed that rates of target vessel failure climbed steadily over five years, reaching 12% of all patients. However, annual risk declined after the first year, reflecting how early recurrence remains the most dangerous period. “The present study demonstrated the enduring prognostic value of post-PCI FFR in patients undergoing second-generation DES implantation, with its inverse association with adverse clinical outcomes persisting over a 5-year follow-up period,” said the paper’s authors. “The prognostic impact of post-PCI FFR on the risk for TVF changed over time.” “However, the consistently higher risk for TVR in the nonstented segment in the low post-PCI FFR group sustained the overall trend of elevated risk for TVF in the low-post-PCI FFR group during the follow-up.” The authors concluded that stent success may require attention beyond the treated lesion itself with the study findings concluding that measuring FFR after implantation could help identify high-risk patients who may benefit from closer monitoring or additional therapies. Disease progression Writing in an accompanying editorial commentary piece, H. V. (“Skip”) Anderson, MD, from the Texas Medical Center in Houston, cautioned that even after successful stent procedures, disease progression continued in the coronary arteries. Dr. Anderson pointed out that long-term outcomes depended on understanding what was happening beyond the stented segment, especially in untreated and microvascular areas. “Annual rates of the combined endpoint of cardiac death or target vessel myocardial infarction were constant over 5 years: 0.8%, 0.7%, 0.8%, 0.5%, and 1.0%, respectively,” he wrote. “This suggests that clinical events reflecting acute target vessel pathology such as sudden plaque rupture were infrequent and relatively constant over time.” Dr. Anderson added that non-target lesion revascularization increased in later years, suggesting a continuing shift toward risks from diffuse disease rather than acute events. He warned that physiological measurements were critical for separating microvascular issues from focal or diffuse atherosclerosis. “Coronary atherosclerosis is relentless. We also must be relentless in our pursuit of understanding it in all its many dimensions and working diligently to mitigate its adverse effects.” Source: Hwang D, Chung J, Yang S, et al. Long-Term and Temporal Relationships Between Post-Stent Fractional Flow Reserve and Clinical Outcomes. JACC Cardiovasc Interv. 2025;18:2863–2874. Image Credit: Rasi– stock.adobe.com