Long-term Patient Prognostication by Coronary Flow Reserve and Index of Microcirculatory Resistance: International Registry of Comprehensive Physiologic Assessment.
Coronary artery disease
Coronary flow reserve
Fractional flow reserve
Index of microcirculatory resistance
Myocardial ischemia
Percutaneous coronary intervention
Journal
Korean circulation journal
ISSN: 1738-5520
Titre abrégé: Korean Circ J
Pays: Korea (South)
ID NLM: 101247141
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
25
02
2020
revised:
04
04
2020
accepted:
13
05
2020
pubmed:
30
7
2020
medline:
30
7
2020
entrez:
30
7
2020
Statut:
ppublish
Résumé
Recent guideline recommends evaluation using of coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients with functionally insignificant stenosis. We evaluated clinical implications of CFR and IMR in patients with high fractional flow reserve (FFR) and deferred revascularization. A total of 867 patients (1,152 vessels) consigned to deferred revascularization who underwent comprehensive physiologic assessments were enrolled. Patients with high FFR (>0.80) were categorized by CFR (≤2) and IMR (≥23 U). Clinical outcome was assessed by patient-oriented composite outcome (POCO), a composite of any death, myocardial infarction (MI), and revascularization at 5 years. Patients with low CFR (≤2) showed significantly greater risk of POCO than those with high CFR (>2) in both high-FFR (p=0.024) and low-FFR (p=0.034) groups. In patients with high FFR, those with low CFR and high IMR (overt microvascular disease) displayed the greatest risk of POCO overall (p=0.015), surpassing those with high CFR and low IMR (HR, 2.873; 95% CI, 1.476-5.594; p=0.002) and showing significantly greater risk of cardiac death or MI (HR, 5.662; 95% CI, 1.984-16.154; p=0.001). Overt microvascular disease was independently associated with POCO in the high-FFR population (HR, 2.282; 95% CI, 1.176-4.429; p=0.015). Among patients with deferred revascularization, those with low CFR showed significantly greater risk of POCO than those with high CFR, regardless of FFR. In patients with high FFR, those with overt microvascular disease showed significantly greater risk of POCO and cardiac death or MI at 5-year, compared with the others. ClinicalTrials.gov Identifier: NCT03690713.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Recent guideline recommends evaluation using of coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients with functionally insignificant stenosis. We evaluated clinical implications of CFR and IMR in patients with high fractional flow reserve (FFR) and deferred revascularization.
METHODS
METHODS
A total of 867 patients (1,152 vessels) consigned to deferred revascularization who underwent comprehensive physiologic assessments were enrolled. Patients with high FFR (>0.80) were categorized by CFR (≤2) and IMR (≥23 U). Clinical outcome was assessed by patient-oriented composite outcome (POCO), a composite of any death, myocardial infarction (MI), and revascularization at 5 years.
RESULTS
RESULTS
Patients with low CFR (≤2) showed significantly greater risk of POCO than those with high CFR (>2) in both high-FFR (p=0.024) and low-FFR (p=0.034) groups. In patients with high FFR, those with low CFR and high IMR (overt microvascular disease) displayed the greatest risk of POCO overall (p=0.015), surpassing those with high CFR and low IMR (HR, 2.873; 95% CI, 1.476-5.594; p=0.002) and showing significantly greater risk of cardiac death or MI (HR, 5.662; 95% CI, 1.984-16.154; p=0.001). Overt microvascular disease was independently associated with POCO in the high-FFR population (HR, 2.282; 95% CI, 1.176-4.429; p=0.015).
CONCLUSION
CONCLUSIONS
Among patients with deferred revascularization, those with low CFR showed significantly greater risk of POCO than those with high CFR, regardless of FFR. In patients with high FFR, those with overt microvascular disease showed significantly greater risk of POCO and cardiac death or MI at 5-year, compared with the others.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov Identifier: NCT03690713.
Identifiants
pubmed: 32725991
pii: 50.e101
doi: 10.4070/kcj.2020.0083
pmc: PMC7515763
doi:
Banques de données
ClinicalTrials.gov
['NCT03690713']
Types de publication
Journal Article
Langues
eng
Pagination
890-903Informations de copyright
Copyright © 2020. The Korean Society of Cardiology.
Déclaration de conflit d'intérêts
Dr. Joo Myung Lee received a research grant from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Bon-Kwon Koo received an Institutional Research Grant from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Escaned received personal fees from Philips Volcano, Boston Scientific, and Abbott/St. Jude Medical outside the submitted work. All other authors declare that there is no conflict of interest relevant to the submitted work.
Références
Circulation. 2013 Dec 17;128(24):2557-66
pubmed: 24141255
Eur Heart J. 2018 Nov 7;39(42):3759
pubmed: 30403801
Circ Cardiovasc Interv. 2014 Jun;7(3):301-11
pubmed: 24782198
Circulation. 2014 Jun 17;129(24):2518-27
pubmed: 24787469
Eur Heart J. 2013 May;34(18):1375-83
pubmed: 23344979
Circulation. 2002 Feb 19;105(7):823-9
pubmed: 11854122
Eur Heart J. 2014 Oct 1;35(37):2541-619
pubmed: 25173339
N Engl J Med. 2014 Sep 25;371(13):1208-17
pubmed: 25176289
Eur Heart J. 2012 Apr;33(7):829-37, 837a-837d
pubmed: 21890489
JACC Cardiovasc Imaging. 2012 Apr;5(4):430-40
pubmed: 22498334
JACC Cardiovasc Interv. 2018 Apr 23;11(8):741-753
pubmed: 29673505
Catheter Cardiovasc Interv. 2008 Feb 15;71(3):291-7
pubmed: 18288725
Circulation. 2011 Jun 14;123(23):2736-47
pubmed: 21670242
N Engl J Med. 2018 Jul 19;379(3):250-259
pubmed: 29785878
Circulation. 1996 Oct 15;94(8):1842-9
pubmed: 8873658
Eur Heart J. 2014 May;35(17):1101-11
pubmed: 24366916
Circ Cardiovasc Interv. 2015 Nov;8(11):e002857
pubmed: 26499500
JACC Cardiovasc Imaging. 2012 Feb;5(2):193-202
pubmed: 22340827
J Am Coll Cardiol. 2016 Mar 15;67(10):1158-1169
pubmed: 26965536
JACC Cardiovasc Interv. 2018 Apr 23;11(8):728-737
pubmed: 29605243
JACC Cardiovasc Imaging. 2013 Jun;6(6):668-71
pubmed: 23764095
JACC Cardiovasc Interv. 2018 Oct 22;11(20):2058-2068
pubmed: 30336810
J Mol Cell Cardiol. 2012 Apr;52(4):857-64
pubmed: 21924273
Atherosclerosis. 2012 Aug;223(2):384-8
pubmed: 22766333
Eur Heart J. 2020 Jan 14;41(3):407-477
pubmed: 31504439
Circulation. 2017 Jun 6;135(23):2241-2251
pubmed: 28356440
Eur Heart J. 2018 Mar 14;39(11):945-951
pubmed: 29020260
JACC Cardiovasc Interv. 2018 Aug 13;11(15):1423-1433
pubmed: 30093048
Circulation. 2006 May 2;113(17):2054-61
pubmed: 16636168
Circ Cardiovasc Interv. 2013 Aug;6(4):329-35
pubmed: 23899871