Clinical outcomes of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention By Coronary Flow Capacity Status in Stable Lesions.
Journal
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
ISSN: 1969-6213
Titre abrégé: EuroIntervention
Pays: France
ID NLM: 101251040
Informations de publication
Date de publication:
20 07 2021
20 07 2021
Historique:
pubmed:
7
7
2020
medline:
21
7
2021
entrez:
7
7
2020
Statut:
epublish
Résumé
Coronary flow capacity (CFC) provides integrated information about coronary flow reserve (CFR) and hyperaemic coronary flow and is useful for identifying coronary flow limitation. The aim of this study was to investigate the effect of percutaneous coronary intervention (PCI) on vessel-related major adverse cardiovascular events (MACE) according to CFC status in stable coronary lesions. From a global, multicentre registry of comprehensive physiological assessment, a total of 1,397 patients (1,694 vessels) were analysed. Low CFC was defined for lesions with reduced CFR and inverse of hyperaemic mean transit time (1/hTmn). A predefined definition of CFC (CFR <2.0 and 1/hTmn less than the corresponding percentile) was assessed first in a multivariable marginal Cox proportional model with the interaction term between CFC status and PCI (performed or not), and then the optimal definition of CFC was explored. We observed a significant interaction between predefined low CFC and PCI (p=0.067). With the optimal definition of CFC (CFR ≤3.2 and 1/hTmn ≤2.8), the HR (95% CI) of PCI was 0.278 (0.103-0.751) and 1.393 (0.783-2.478) in lesions with low and normal CFC, respectively. If lesions with fractional flow reserve (FFR) ≤0.8 and normal CFC had been deferred, the number of PCI would have decreased by 64%. FFR-guided PCI for low CFC lesions was associated with reduced incidence of MACE in low CFC but not in normal CFC lesions. Our results suggest the potential use of CFC in combination with FFR for optimising the indication for PCI by reducing potentially unbeneficial PCI. https://clinicaltrials.gov/ct2/show/NCT03690713.
Sections du résumé
BACKGROUND
Coronary flow capacity (CFC) provides integrated information about coronary flow reserve (CFR) and hyperaemic coronary flow and is useful for identifying coronary flow limitation.
AIMS
The aim of this study was to investigate the effect of percutaneous coronary intervention (PCI) on vessel-related major adverse cardiovascular events (MACE) according to CFC status in stable coronary lesions.
METHODS
From a global, multicentre registry of comprehensive physiological assessment, a total of 1,397 patients (1,694 vessels) were analysed. Low CFC was defined for lesions with reduced CFR and inverse of hyperaemic mean transit time (1/hTmn). A predefined definition of CFC (CFR <2.0 and 1/hTmn less than the corresponding percentile) was assessed first in a multivariable marginal Cox proportional model with the interaction term between CFC status and PCI (performed or not), and then the optimal definition of CFC was explored.
RESULTS
We observed a significant interaction between predefined low CFC and PCI (p=0.067). With the optimal definition of CFC (CFR ≤3.2 and 1/hTmn ≤2.8), the HR (95% CI) of PCI was 0.278 (0.103-0.751) and 1.393 (0.783-2.478) in lesions with low and normal CFC, respectively. If lesions with fractional flow reserve (FFR) ≤0.8 and normal CFC had been deferred, the number of PCI would have decreased by 64%.
CONCLUSIONS
FFR-guided PCI for low CFC lesions was associated with reduced incidence of MACE in low CFC but not in normal CFC lesions. Our results suggest the potential use of CFC in combination with FFR for optimising the indication for PCI by reducing potentially unbeneficial PCI.
CLINICAL TRIALS REGISTRATION
https://clinicaltrials.gov/ct2/show/NCT03690713.
Identifiants
pubmed: 32624458
pii: EIJ-D-20-00401
doi: 10.4244/EIJ-D-20-00401
pmc: PMC9724928
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT03690713']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e301-e308Investigateurs
Yoshihisa Kanaji
(Y)
Yoshinori Kanno
(Y)
Masahiro Hada
(M)
Haruhito Yuki
(H)
Masao Yamaguchi
(M)
Hiroaki Ohya
(H)
Yohei Sumino
(Y)
Hidenori Hirano
(H)
Tomoki Horie
(T)
Eisuke Usui
(E)
Akinori Sugano
(A)
Tomoyo Sugiyama
(T)
Tadashi Murai
(T)
Tetsumin Lee
(T)
Ki Hong Choi
(KH)
Doyeon Hwang
(D)
Jonghanne Park
(J)
Ji-Hyun Jung
(JH)
Hyung Yoon Kim
(HY)
Hae Won Jung
(HW)
Yun-Kyeong Cho
(YK)
Hyuck-Jun Yoon
(HJ)
Young Bin Song
(YB)
Joo-Yong Hahn
(JY)
Joon-Hyung Doh
(JH)
Chang-Wook Nam
(CW)
Eun-Seok Shin
(ES)
Seung-Ho Hur
(SH)
Hernán Mejía-Rentería
(H)
Francesco Lauri
(F)
Sonoka Goto
(S)
Fernando Macaya
(F)
Angela McInerney
(A)
Giacomo Gravina
(G)
Rafael Vera
(R)
Nieves Gonzalo
(N)
Pilar Jimenez-Quevedo
(P)
Ivan Nuñez-Gil
(I)
Pablo Salinas
(P)
Luis Nombela-Franco
(L)
Maria del Trigo
(M)
Antonio Fernández-Ortiz
(A)
Carlos Macaya
(C)
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