Post-occlusional hyperemia for fractional flow reserve assessment and pull-back curve analysis

Balloon occlusion is a potential method for inducing hyperemia to measure post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR). The objective of this study was to determine the clinical usefulness of post-occlusional hyperemia. FFRs measured using post-occlusional hyperemia caused by 30 (FFR occl30 ) and 60 s (FFR occl60 ) of balloon occlusion after PCI were compared in 60 lesions from 60 patients. The duration of hyperemia was also measured. There was a strong correlation between FFR occl30 and FFR occl60 ( r = 0.969, p < 0.01). The duration of hyperemia was significantly longer with FFR occl60 than with FFR occl30 (68 ± 23 vs. 37 ± 15 s, p < 0.01). The time required for pullback curve analysis was around 45 s. However, in 7 (12%) cases, the duration of hyperemia with FFR occl60 was < 45 s, which was not enough for pull-back curve analysis. To predict the duration of hyperemia with FFR occl60 ≥ 45 s, the receiver operating characteristic curve analysis revealed a cut-off value of 25 s of hyperemia with FFR occl30 . FFR occl30 is sufficient for diagnostic purposes. FFR occl60 is suitable for pull-back curve analysis in select cases based on predictions made using the duration of hyperemia with FFR occl30 .