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Puymirat E, Cayla G, Simon T, Steg PG, Montalescot G, Durand-Zaleski I, Ngaleu Siaha F, Gallet R, Khalife K, Morelle JF, Motreff P, Lemesle G, Dillinger JG, Lhermusier T, Silvain J, Roule V, Labèque JN, Rangé G, Ducrocq G, Cottin Y, Blanchard D, Charles Nelson A, Djadi-Prat J, Chatellier G, Danchin N. Three-Year Outcomes With Fractional Flow Reserve-Guided or Angiography-Guided Multivessel Percutaneous Coronary Intervention for Myocardial Infarction. Circ Cardiovasc Interv 2024; 17:e013913. [PMID: 38785084 DOI: 10.1161/circinterventions.123.013913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/28/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND In patients with multivessel disease with successful primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction, the FLOWER-MI trial (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) showed that a fractional flow reserve (FFR)-guided strategy was not superior to an angiography-guided strategy for treatment of noninfarct-related artery lesions regarding the 1-year risk of death from any cause, myocardial infarction, or unplanned hospitalization leading to urgent revascularization. The extension phase of the trial was planned using the same primary outcome to determine whether a difference in outcomes would be observed with a longer follow-up. METHODS In this multicenter trial, we randomly assigned patients with ST-segment-elevation myocardial infarction and multivessel disease with successful percutaneous coronary intervention of the infarct-related artery to receive complete revascularization guided by either FFR (n=586) or angiography (n=577). RESULTS After 3 years, a primary outcome event occurred in 52 of 498 patients (9.40%) in the FFR-guided group and in 44 of 502 patients (8.17%) in the angiography-guided group (hazard ratio, 1.19 [95% CI, 0.79-1.77]; P=0.4). Death occurred in 22 patients (4.00%) in the FFR-guided group and in 23 (4.32%) in the angiography-guided group (hazard ratio, 0.96 [95% CI, 0.53-1.71]); nonfatal myocardial infarction in 23 (4.13%) and 14 (2.56%), respectively (hazard ratio, 1.63 [95% CI, 0.84-3.16]); and unplanned hospitalization leading to urgent revascularization in 21 (3.83%) and 18 (3.36%; hazard ratio, 1.15 [95% CI, 0.61-2.16]), respectively. CONCLUSIONS Although event rates in the trial were lower than expected, in patients with ST-segment-elevation myocardial infarction undergoing complete revascularization, an FFR-guided strategy did not have a significant benefit over an angiography-guided strategy with respect to the risk of death, myocardial infarction, or urgent revascularization up to 3 years. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02943954.
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Affiliation(s)
- Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital européen Georges Pompidou, France (E.P., D.B., N.D.)
- Université de Paris, France (E.P., D.B., N.D., G.D.)
- French Alliance for Cardiovascular Trials, Paris, France (E.P., T.S., P.G.S., G.L., G.D., N.D.)
| | | | - Tabassome Simon
- French Alliance for Cardiovascular Trials, Paris, France (E.P., T.S., P.G.S., G.L., G.D., N.D.)
- Department of Clinical Pharmacology, AP-HP, Hôpital Saint Antoine, Unité de Recherche Clinique, France (T.S.)
- Université Pierre et Marie Curie (UPMC-Paris 06), INSERM U-698, Paris, France (T.S.)
| | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Trials, Paris, France (E.P., T.S., P.G.S., G.L., G.D., N.D.)
- Université de Paris, INSERM Unité-1148, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, France (P.G.S.)
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie (APHP), INSERM UMRS 1166, Paris, France (G.M., J.S.)
| | - Isabelle Durand-Zaleski
- Clinical Research Unit Eco Ile de France, Hôpital Hôtel Dieu, AP-HP, France (I.D.-Z., F.N.S.)
| | - Fabiola Ngaleu Siaha
- Clinical Research Unit Eco Ile de France, Hôpital Hôtel Dieu, AP-HP, France (I.D.-Z., F.N.S.)
| | - Romain Gallet
- Service de Cardiologie, APHP, Hôpitaux Universitaires Henri Mondor, Créteil, France (R.G.)
- U955-IMRB, Equipe 03, Inserm, Univ Paris Est Creteil, École Nationale Vétérinaire D'Alfort, Maisons-Alfort, France (R.G.)
| | | | | | - Pascal Motreff
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, UMR 6602, Université Clermont Auvergne, France (P.M.)
| | - Gilles Lemesle
- French Alliance for Cardiovascular Trials, Paris, France (E.P., T.S., P.G.S., G.L., G.D., N.D.)
- Cardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, France (G.L.)
- Heart and Lung Institute, University Hospital of Lille, Institut Pasteur of Lille, Inserm, France (G.L.)
| | - Jean-Guillaume Dillinger
- Department of Cardiology, Hôpital Lariboisière, AP-HP, Inserm U-942, Université de Paris, France (J.-G.D.)
| | - Thibault Lhermusier
- Department of Cardiology, Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France (T.L.)
- Medical School, Toulouse III Paul Sabatier University, France (T.L.)
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie (APHP), INSERM UMRS 1166, Paris, France (G.M., J.S.)
| | - Vincent Roule
- Cardiology Department, Caen University Hospital, France (V.R.)
| | | | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, France (G.R.)
| | - Grégory Ducrocq
- Université de Paris, France (E.P., D.B., N.D., G.D.)
- French Alliance for Cardiovascular Trials, Paris, France (E.P., T.S., P.G.S., G.L., G.D., N.D.)
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, French Alliance for Cardiovascular Trials, INSERM U1148, Laboratory for Vascular Translational Science, France (G.D.)
| | - Yves Cottin
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires, EA 7460, University of Bourgogne Franche-Comté, Dijon, France (Y.C.)
- Cardiology Department, University Hospital Centre of Dijon Bourgogne, Dijon, France (Y.C.)
| | - Didier Blanchard
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital européen Georges Pompidou, France (E.P., D.B., N.D.)
- Université de Paris, France (E.P., D.B., N.D., G.D.)
| | - Anaïs Charles Nelson
- Clinical Research Unit, George-Pompidou European Hospital, AP-HP, CIC-EC1418, Inserm, France (A.C.N., J.D.-P., G.C.)
| | - Juliette Djadi-Prat
- Clinical Research Unit, George-Pompidou European Hospital, AP-HP, CIC-EC1418, Inserm, France (A.C.N., J.D.-P., G.C.)
| | - Gilles Chatellier
- Clinical Research Unit, George-Pompidou European Hospital, AP-HP, CIC-EC1418, Inserm, France (A.C.N., J.D.-P., G.C.)
| | - Nicolas Danchin
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital européen Georges Pompidou, France (E.P., D.B., N.D.)
- Université de Paris, France (E.P., D.B., N.D., G.D.)
- French Alliance for Cardiovascular Trials, Paris, France (E.P., T.S., P.G.S., G.L., G.D., N.D.)
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Huang Z, Ding Y, Yang Y, Zhao S, Zhang S, Xiao J, Ding C, Guo N, Li Z, Zhou S, Cao G, Wang X. Performance of machine learning-based coronary computed tomography angiography for selecting revascularization candidates. Acta Radiol 2024; 65:123-132. [PMID: 36847335 DOI: 10.1177/02841851231158730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Limited studies have investigated the accuracy of therapeutic decision-making using machine learning-based coronary computed tomography angiography (ML-CCTA) compared with CCTA. PURPOSE To investigate the performance of ML-CCTA for therapeutic decision compared with CCTA. MATERIAL AND METHODS The study population consisted of 322 consecutive patients with stable coronary artery disease. The SYNTAX score was calculated with an online calculator based on ML-CCTA results. Therapeutic decision-making was determined by ML-CCTA results and the ML-CCTA-based SYNTAX score. The therapeutic strategy and the appropriate revascularization procedure were selected using ML-CCTA, CCTA, and invasive coronary angiography (ICA) independently. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, accuracy of ML-CCTA and CCTA for selecting revascularization candidates were 87.01%, 96.43%, 95.71%, 89.01%, 91.93%, and 85.71%, 87.50%, 86.27%, 86.98%, 86.65%, respectively, using ICA as the standard reference. The area under the receiver operating characteristic curve (AUC) of ML-CCTA for selecting revascularization candidates was significantly higher than CCTA (0.917 vs. 0.866, P = 0.016). Subgroup analysis showed the AUC of ML-CCTA for selecting percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) candidates was significantly higher than CCTA (0.883 vs. 0.777, P < 0.001, 0.912 vs. 0.826, P = 0.003, respectively). CONCLUSION ML-CCTA could distinguish between patients who need revascularization and those who do not. In addition, ML-CCTA showed a slightly superior to CCTA in making an appropriate decision for patients and selecting a suitable revascularization strategy.
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Affiliation(s)
- Zengfa Huang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Ding
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Yang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengchao Zhao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shutong Zhang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianwei Xiao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengyu Ding
- Shukun (Beijing) Technology Co., Ltd., Beijing, China
| | - Ning Guo
- Shukun (Beijing) Technology Co., Ltd., Beijing, China
| | - Zuoqin Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiguang Zhou
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guijuan Cao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Nogi K, Soeda T, Hara M, Iwama H, Toyokawa N, Sakai S, Yano H, Iwai A, Hashimoto Y, Fujimoto H, Suzuki M, Nakai T, Doi N, Saito Y. Functional assessment of intermediate coronary artery stenosis with 4-Fr catheters. Heart Vessels 2021; 36:638-645. [PMID: 33389064 DOI: 10.1007/s00380-020-01746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
The 4-Fr catheter system is not recommended for invasive functional assessment of coronary artery stenosis, because it tends to distort the aortic waveform. This study aimed to identify the incidence of aortic waveform distortion and a feasible method for correct diagnosis of coronary artery stenosis with a 4-Fr catheter. We retrospectively investigated 178 lesions with intermediate coronary artery stenosis. Non-hyperemic distal coronary artery pressure (Pd) and aortic pressure (Pa) were measured with a 4-Fr diagnostic or 6-Fr guiding catheter before and after saline flush. The mean Pd/mean Pa (Pd/Pa) and instantaneous wave-free ratio (iFR) were calculated before and after flushing. We compared the effect of flushing on the changes in Pd/Pa and iFR between the 4-Fr diagnostic and 6-Fr guiding catheters. Using the 4-Fr diagnostic catheter, there was a significant decrease in incidence of aortic waveform distortion from 42.0% (47 lesions) before flushing to 1.8% (2 lesions) after flushing (p < 0.001); the incidence was only 3.0% before saline flush and decreased to 0% after saline flush when using the 6-Fr guiding catheter. The presence of aortic waveform distortion influenced the iFR when the 4-Fr system was used. Functional measurements with the 4-Fr diagnostic catheter require adequate saline flush to remove the influence of aortic waveform distortion.
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Affiliation(s)
- Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.,Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.
| | - Masahiko Hara
- Center for Community-Based Healthcare Research and Education, Shimane University, Izumo, Japan
| | - Hajime Iwama
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Nozomi Toyokawa
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Satoshi Sakai
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Hiroki Yano
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.,Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Atsushi Iwai
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.,Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Hajime Fujimoto
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Megumi Suzuki
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Takehito Nakai
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Naofumi Doi
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
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Puymirat E, Simon T, de Bruyne B, Montalescot G, Steg G, Cayla G, Durand-Zaleski I, Blanchard D, Danchin N, Chatellier G. Rationale and design of the Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction (FLOWER-MI) trial. Am Heart J 2020; 222:1-7. [PMID: 32000067 DOI: 10.1016/j.ahj.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In ST-elevation myocardial infarction (STEMI) patients presenting with multivessel disease (MVD), recent studies have demonstrated the superiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for non-culprit lesions compared to culprit lesion treatment-only therapy. FFR- and angio-guided PCI have however never been compared in STEMI patients. TRIAL DESIGN FLOWER-MI is an open-label multicenter national randomized clinical trial. The aim is to investigate FFR-guided complete revascularization in comparison to angio-guided complete revascularization in STEMI patients with successful PCI of the culprit lesion and ≥50% stenosis in at least one additional non-culprit lesion requiring PCI. Eligible patients will be randomized after successful primary PCI in a 1:1 fashion to either FFR-guided or angio-guided complete revascularization during the index procedure or a staged procedure before discharge (≤5 days). Patients assigned to FFR guidance first have FFR measured in each non-culprit vessel and only undergo PCI if FFR is ≤0.80. The primary end point of the study is a composite of major adverse cardiac events, including all-cause death, non-fatal MI, and unplanned hospitalization leading to urgent revascularization at 1 year. Secondary end points will include the individual adverse events, cost-effectiveness, quality of life, and 30-day, 6-month, and 3-year outcomes. Based on estimated event rates, a sample size of 1170 patients is needed to show superiority of the FFR-guided revascularization with 80% power. CONCLUSION The aim of FLOWER-MI trial is to assess whether FFR-guided complete revascularization in the acute setting is superior angio-guided complete revascularization.
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De Rosa S, Polimeni A, Petraco R, Davies JE, Indolfi C. Diagnostic Performance of the Instantaneous Wave-Free Ratio: Comparison With Fractional Flow Reserve. Circ Cardiovasc Interv 2019; 11:e004613. [PMID: 29326150 DOI: 10.1161/circinterventions.116.004613] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/16/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Aim of the present study was to perform a meta-analysis of all available studies comparing the instantaneous wave-free ratio (iFR) with fractional flow reserve (FFR). METHODS AND RESULTS Published trials comparing the iFR with FFR were searched for in PubMed, Google Scholar, and Scopus electronic databases. A total of 23 studies were available for the analysis, including 6381 stenoses. First, a meta-analysis of all studies was performed exploring the correlation between FFR and iFR. Interestingly, we found good correlation (0.798 [0.78-0.82]) between the 2 indices (P<0.001). In addition, to evaluate the diagnostic performance of iFR to identify FFR-positive coronary stenoses, we performed an additional meta-analysis, summarizing the results of receiver operating characteristics analyses from individual studies reporting the area under the curve. Summing the results of these studies, we found that iFR has a good diagnostic performance for the identification of FFR-positive stenoses (area under the curve=0.88 [0.86-0.90]; P<0.001). Furthermore, our search results included 5 studies that compared iFR and FFR to a third independent reference standard. Interestingly, no significant differences between iFR and FFR were reported in those studies. CONCLUSIONS The present meta-analysis shows that iFR significantly correlates with standard FFR and shows a good diagnostic performance in identifying FFR-positive coronary stenoses. Finally, iFR and FFR have similar diagnostic efficiency for detection of ischemia-inducing stenoses when tested against a third comparator.
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Affiliation(s)
- Salvatore De Rosa
- From the Division of Cardiology, Department of Medical and Surgical Sciences (S.D.R., A.P., C.I.) and URT-CNR of IFC (C.I.), Magna Graecia University, Catanzaro, Italy; and National Heart and Lung Institute, Imperial College London, United Kingdom (R.P., J.E.D.)
| | - Alberto Polimeni
- From the Division of Cardiology, Department of Medical and Surgical Sciences (S.D.R., A.P., C.I.) and URT-CNR of IFC (C.I.), Magna Graecia University, Catanzaro, Italy; and National Heart and Lung Institute, Imperial College London, United Kingdom (R.P., J.E.D.)
| | - Ricardo Petraco
- From the Division of Cardiology, Department of Medical and Surgical Sciences (S.D.R., A.P., C.I.) and URT-CNR of IFC (C.I.), Magna Graecia University, Catanzaro, Italy; and National Heart and Lung Institute, Imperial College London, United Kingdom (R.P., J.E.D.)
| | - Justin E Davies
- From the Division of Cardiology, Department of Medical and Surgical Sciences (S.D.R., A.P., C.I.) and URT-CNR of IFC (C.I.), Magna Graecia University, Catanzaro, Italy; and National Heart and Lung Institute, Imperial College London, United Kingdom (R.P., J.E.D.)
| | - Ciro Indolfi
- From the Division of Cardiology, Department of Medical and Surgical Sciences (S.D.R., A.P., C.I.) and URT-CNR of IFC (C.I.), Magna Graecia University, Catanzaro, Italy; and National Heart and Lung Institute, Imperial College London, United Kingdom (R.P., J.E.D.).
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Honda K, Yuzaki M, Kaneko M, Nakai T, Kunimoto H, Nagashima M, Nishimura Y. Functional Evaluation of the Myocardial Ischemia After Coronary Artery Bypass Surgery Using Coronary Flow Velocity Reserve in Left Ventricular Hypertrophy. Semin Thorac Cardiovasc Surg 2019; 31:166-173. [DOI: 10.1053/j.semtcvs.2018.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/21/2018] [Indexed: 12/31/2022]
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Shaheen M, Mokarrab M, Youssef A, Aref M, Abushouk AI, Elmaraezy A, Almasswary A. Physiological evaluation of the provisional side-branch intervention strategy for bifurcation lesions using instantaneous wave-free ratio. Indian Heart J 2018; 70 Suppl 3:S254-S258. [PMID: 30595269 PMCID: PMC6309120 DOI: 10.1016/j.ihj.2018.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 01/10/2023] Open
Abstract
Background The provisional side-branch intervention strategy remains the gold standard approach for repair of coronary bifurcation lesions. We performed this study to evaluate the clinical and functional outcomes of using the instantaneous wave-free ratio (iFR) for physiological assessment in provisional side-branch repair of bifurcation lesions. Methods Fifty patients with coronary bifurcation lesions were equally divided into two groups: (I) an iFR-guided side-branch intervention group and (II) a conventional group, in which the operator selected a different interventional method. After the procedure, we performed a six-month follow-up for postoperative ejection fraction (EF) and clinical cardiac outcomes. Results Our results showed that the iFR measurement procedure was technically feasible in bifurcation lesions, with no procedural-related complications. Moreover, measuring iFR significantly predicted the side-branch percent stenosis after stenting of the main branch (r = −0.81, p < 0.0001). Compared to the conventional group, the iFR-guided group showed a significantly shorter procedural time (MD = −14.6 min, 95% CI [−27.7, −1.4]) and hospital stay duration (MD = −0.92 days, 95% CI [−1.6, −0.28]). However, no significant differences were recorded between the iFR-guided and conventional groups in terms of postoperative EF (p = 0.9), six-month heart failure class (p = 0.89), or post-interventional angina (p = 0.066). Conclusion Using iFR for physiological assessment during the provisional side-branch intervention strategy can reduce the procedural time and length of hospital stay in patients with bifurcation lesions. Larger trials should compare the clinical outcomes of iFR to other physiological assessment methods such as the fractional flow reserve (FFR) in patients with coronary bifurcation lesions. ClinicalTrials.gov number: NCT02785510
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Affiliation(s)
- Mohamed Shaheen
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Moustafa Mokarrab
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali Youssef
- Department of Cardiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mansour Aref
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Ahmed Elmaraezy
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt
| | - Adel Almasswary
- Department of Cardiology, Aseer Central Hospital, Abha, Saudi Arabia
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Kikoïne J, Lebon M, Gouffran G, Millischer D, Cattan S, Nallet O. [Measurement of fractional flow reserve in patients with severe aortic stenosis: A valid test?]. Ann Cardiol Angeiol (Paris) 2016; 65:366-369. [PMID: 27692748 DOI: 10.1016/j.ancard.2016.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Abstract
A 54-year-old woman was hospitalized for an acute pulmonary oedema revealing a severe aortic stenosis (AS) associated with an aortic aneurysm and a left ventricular hypertrophy (LVH). The coronary angiography found an equivocal left main lesion. Fractional flow reserve (FFR) showed hemodynamic significance (FFR=0.78) and optical coherence tomography confirmed this result with a minimal lumen area of 4.9mm2. FFR-guided percutaneous intervention is reported to improve outcome in patients with stable coronary disease. However, only few data are available in cases of AS. In this condition, secondary LVH is associated with microcirculatory dysfunction, which interferes with optimal hyperemia. An elevated right atrial pressure could also modify FFR measurement. This risk of underestimation of a coronary lesion in patients with severe AS has to be taken into consideration in clinical practice.
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Affiliation(s)
- J Kikoïne
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France
| | - M Lebon
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France
| | - G Gouffran
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France
| | - D Millischer
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France
| | - S Cattan
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France
| | - O Nallet
- Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France.
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Hu P, Tang MY, Song WC, Jiang J, Sun Y, Liu XB, Li CL, Hu XY, Wang JA. Fractional Flow Reserve Guided Percutaneous Coronary Intervention Improves Clinical Outcome with Reduced Cost in Contemporary Clinical Practice. Chin Med J (Engl) 2015; 128:2000-5. [PMID: 26228209 PMCID: PMC4717962 DOI: 10.4103/0366-6999.161341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Fractional flow reserve (FFR) is currently considered as the gold standard for evaluating the functional significance of coronary stenosis. However, its potential benefits in real-world practice remain unknown in China. This study aimed to test the hypothesis that the use of FFR is associated with improved outcome and reduced cost in Chinese real-world clinical practice. METHODS A retrospective cohort study was carried out using the database of Second Affiliated Hospital of Zhejiang University, a tertiary and high-volume center in China. Clinical events were compared using the Cox proportional hazards model during a median follow-up of 13 months. RESULTS The study cohort consisted of 366 consecutive patients referred for coronary revascularization with adjunct FFR and 366 matched controls, from 2010 to 2014. Major adverse cardiac events (MACEs) (death, myocardial infarction, repeated revascularization, or hospitalization for angina) at 4 years were found in 12.0% of angiography-guided patients and 4.9% in the FFR-guided group (P < 0.001). The mean number of implanted stents was significantly lower in FFR treated subjects (0.52 ± 0.82 stents) compared with the angiography-guided group (0.93 ± 0.96 stents) (P < 0.001). No difference in overall costs at initial hospitalization was observed between angiography-guided percutaneous coronary intervention (PCI) compared with FFR-guided PCI (RMB 33,000 Yuan, range: RMB 7393-44,700 Yuan) versus RMB 21,200 Yuan (RMB 19,100-47,100 Yuan) (P = 0.54). However, costs for MACEs during follow-up were significantly reduced in the FFR-guided arm (P < 0.001). CONCLUSIONS In the contemporary clinical practice, FFR-guided PCI is associated with decreased use of stents, improved clinical outcome, and reduced costs, compared with angiography-guided PCI.
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Affiliation(s)
- Po Hu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
- Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Meng-Yao Tang
- Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Wen-Chao Song
- Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Jun Jiang
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
- Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Yong Sun
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
- Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Xian-Bao Liu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
- Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Chang-Ling Li
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
- Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Xin-Yang Hu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
- Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Jian-An Wang
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
- Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
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Qi X, Fan G, Zhu D, Ma W, Yang C. Comprehensive assessment of coronary fractional flow reserve. Arch Med Sci 2015; 11:483-93. [PMID: 26170840 PMCID: PMC4495145 DOI: 10.5114/aoms.2015.52351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 07/30/2013] [Accepted: 08/01/2013] [Indexed: 02/06/2023] Open
Abstract
Fractional flow reserve (FFR) is considered nowadays as the gold standard for invasive assessment of physiologic stenosis significance and an indispensable tool for decision-making in coronary revascularization. Robust studies have shown that FFR is more effective in accurately identifying which lesions should be stented, and revascularization guided by FFR improves the outcome of coronary artery disease in patients. Therefore, FFR has been upgraded to a class A recommendation in current guidelines when the ischemic potential for specific target lesions is controversial. This article reviews the laboratory practice, functional evaluation of FFR as a gold standard and its emerging clinical application. In addition, novel noninvasive technologies of FFR measurement are discussed in depth.
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Affiliation(s)
- Xiaolong Qi
- Division of Gastroenterology, Institute of Digestive Disease, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoxin Fan
- Division of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Deqiu Zhu
- Division of Pharmacy, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wanrong Ma
- Division of Gastroenterology, Institute of Digestive Disease, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Changqing Yang
- Division of Gastroenterology, Institute of Digestive Disease, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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11
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Abstract
Pressure-wire technology, most typically fractional flow reserve (FFR), has provided interventional cardiologists with a means of determining the physiological importance of a stenosis during angiography. There has been renewed interest in coronary physiology in the light of guideline recognition, ongoing clinical research and new technologies changing the paradigm of how assessment is performed in the catheter laboratory. We reflect on FFR, with regards the potential effects of changing hemodynamics on FFR and the latest evidence with regards to outcomes. We also review the instantaneous wave-free ratio (iFR), a new pressure-only index, measured at rest, that is under active evaluation in several international randomized controlled trials. We review the accumulated evidence and discuss the important physiological concepts between pressure and flow that underlie the approach to using resting indices. Finally we investigate future developments, including physiological mapping with iFR-Pullback and the potential to predict the hemodynamic effect of stenting.
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Indolfi C, Mongiardo A, Spaccarotella C, Torella D, Caiazzo G, Polimeni A, Sorrentino S, Micieli M, Sabatino J, Curcio A, De Rosa S. The instantaneous wave-free ratio (iFR) for evaluation of non-culprit lesions in patients with acute coronary syndrome and multivessel disease. Int J Cardiol 2014; 178:46-54. [PMID: 25464218 DOI: 10.1016/j.ijcard.2014.03.210] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/25/2014] [Accepted: 03/03/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Adenosine administration is currently required for evaluation of stenosis severity with fractional flow reserve (FFR). The instantaneous wave-free ratio (iFR) was recently introduced as an adenosine-free alternative in patients with stable CAD. The aim of the present study was to replicate the findings of previous iFR studies using an independent calculation algorithm and to evaluate the iFR for the assessment of non-culprit vessels in patients with acute coronary syndrome (ACS). METHODS AND RESULTS 53 patients with ACS (65%) and at least one non-culprit intermediate lesion and 29 (35%) with stable CAD were included. A total of 123 stenoses were evaluated with both FFR and iFR. Classification match of iFR in ACS was not inferior to stable CAD (79.5% in ACS and 84.4% in CAD; p=0.497). Accordingly, no difference was observed in iFR/FFR correlation between ACS and stable CAD (r=0.66 in ACS vs. r=0.69 in CAD). Overall, a significant correlation was found between iFR and FFR (r=0.68; p<0.001) with a good diagnostic efficiency at ROC analysis (area under the curve: 0.87). In addition, neither the localization of the stenosis within the coronary tree (p=0.147) nor the time interval from the acute event (p=0.550) significantly influenced the concordance of iFR with FFR. CONCLUSIONS The iFR is a promising method for the assessment of non-culprit lesion severity in patients with acute coronary syndrome.
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Affiliation(s)
- Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; URT-CNR, Magna Graecia University, Catanzaro, Italy.
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Daniele Torella
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Gianluca Caiazzo
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Mariella Micieli
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Jolanda Sabatino
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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Hennigan B, Layland J, Fearon WF, Oldroyd KG. Fractional flow reserve and the index of microvascular resistance in patients with acute coronary syndromes. EUROINTERVENTION 2014; 10 Suppl T:T55-63. [DOI: 10.4244/eijv10sta10] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Arbab-Zadeh A. Fractional flow reserve-guided percutaneous coronary intervention is not a valid concept. Circulation 2014; 129:1871-8; discussion 1878. [PMID: 24799503 DOI: 10.1161/circulationaha.113.003583] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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15
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[ST segment elevation myocardial infarction: what is the best timing for revascularization of non-culprit lesions?]. Ann Cardiol Angeiol (Paris) 2014; 63:262-4. [PMID: 24834992 DOI: 10.1016/j.ancard.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
Abstract
Approximately 50% of patients admitted for ST-elevation myocardial infarction (STEMI) have multi-vessel disease. Current guidelines recommend revascularization of the culprit lesion only during the initial procedure except in cardiogenic shock. Benefits of revascularization of associated functional lesions are not debate. However, timing of the procedure is not clear. This article is a review over timing of secondary revascularization in STEMI patients with multi-vessels disease.
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Nijjer SS, Sen S, Petraco R, Sachdeva R, Cuculi F, Escaned J, Broyd C, Foin N, Hadjiloizou N, Foale RA, Malik I, Mikhail GW, Sethi AS, Al-Bustami M, Kaprielian RR, Khan MA, Baker CS, Bellamy MF, Hughes AD, Mayet J, Kharbanda RK, Di Mario C, Davies JE. Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio. Heart 2013; 99:1740-8. [PMID: 24047640 PMCID: PMC3841762 DOI: 10.1136/heartjnl-2013-304387] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective To determine whether the instantaneous wave-free ratio (iFR) can detect improvement in stenosis significance after percutaneous coronary intervention (PCI) and compare this with fractional flow reserve (FFR) and whole cycle Pd/Pa. Design A prospective observational study was undertaken in elective patients scheduled for PCI with FFR ≤0.80. Intracoronary pressures were measured at rest and during adenosine-mediated vasodilatation, before and after PCI. iFR, Pd/Pa and FFR values were calculated using the validated fully automated algorithms. Setting Coronary catheter laboratories in two UK centres and one in the USA. Patients 120 coronary stenoses in 112 patients were assessed. The mean age was 63±10 years, while 84% were male; 39% smokers; 33% with diabetes. Mean diameter stenosis was 68±16% by quantitative coronary angiography. Results Pre-PCI, mean FFR was 0.66±0.14, mean iFR was 0.75±0.21 and mean Pd/Pa 0.83±0.16. PCI increased all indices significantly (FFR 0.89±0.07, p<0.001; iFR 0.94±0.05, p<0.001; Pd/Pa 0.96±0.04, p<0.001). The change in iFR after intervention (0.20±0.21) was similar to ΔFFR 0.22±0.15 (p=0.25). ΔFFR and ΔiFR were significantly larger than resting ΔPd/Pa (0.13±0.16, both p<0.001). Similar incremental changes occurred in patients with a higher prevalence of risk factors for microcirculatory disease such as diabetes and hypertension. Conclusions iFR and FFR detect the changes in coronary haemodynamics elicited by PCI. FFR and iFR have a significantly larger dynamic range than resting Pd/Pa. iFR might be used to objectively document improvement in coronary haemodynamics following PCI in a similar manner to FFR.
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Qi X, Lv H, Zhou F, Zhao J, Xu J, Xiang L, Wang F, Zhan Q, Jiang J, Xiao J. A novel noninvasive method for measuring fractional flow reserve through three-dimensional modeling. Arch Med Sci 2013; 9:581-3. [PMID: 23847686 PMCID: PMC3701973 DOI: 10.5114/aoms.2013.35020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 09/10/2012] [Accepted: 09/16/2012] [Indexed: 11/17/2022] Open
Affiliation(s)
- Xiaolong Qi
- Experimental Center of Life Sciences and Regeneration Lab, School of Life Science, Shanghai University, Shanghai, China
- Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huijie Lv
- Division of Mathematics, Tongji University, Shanghai, China
| | - Fangyu Zhou
- Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiangmin Zhao
- Department of Radiology, Shanghai Third People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiahong Xu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li Xiang
- Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Fei Wang
- Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qing Zhan
- Department of Neurology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinfa Jiang
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junjie Xiao
- Experimental Center of Life Sciences and Regeneration Lab, School of Life Science, Shanghai University, Shanghai, China
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Li J, Elrashidi MY, Flammer AJ, Lennon RJ, Bell MR, Holmes DR, Bresnahan JF, Rihal CS, Lerman LO, Lerman A. Long-term outcomes of fractional flow reserve-guided vs. angiography-guided percutaneous coronary intervention in contemporary practice. Eur Heart J 2013; 34:1375-83. [PMID: 23344979 DOI: 10.1093/eurheartj/eht005] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Fractional flow reserve (FFR) is the reference standard for the assessment of the functional significance of coronary artery stenoses, but is underutilized in daily clinical practice. We aimed to study long-term outcomes of FFR-guided percutaneous coronary intervention (PCI) in the general clinical practice. METHODS AND RESULTS In this retrospective study, consecutive patients (n = 7358), referred for PCI at the Mayo Clinic between October 2002 and December 2009, were divided in two groups: those undergoing PCI without (PCI-only, n = 6268) or with FFR measurements (FFR-guided, n = 1090). The latter group was further classified as the FFR-Perform group (n = 369) if followed by PCI, and the FFR-Defer group (n = 721) if PCI was deferred. Clinical events were compared during a median follow-up of 50.9 months. The Kaplan-Meier fraction of major adverse cardiac events at 7 years was 57.0% in the PCI-only vs. 50.0% in the FFR-guided group (P = 0.016). Patients with FFR-guided interventions had a non-significantly lower rate of death or myocardial infarction compared with those with angiography-guided interventions [hazard ratio (HR): 0.85, 95% CI: 0.71-1.01, P = 0.06]; the FFR-guided deferred-PCI strategy was independently associated with reduced rate of myocardial infarction (HR: 0.46, 95% CI: 0.26-0.82, P = 0.008). After excluding patients with FFR of 0.75-0.80 and deferring PCI, the use of FFR was significantly associated with reduced rate of death or myocardial infarction (HR: 0.80, 95% CI: 0.66-0.96, P = 0.02). CONCLUSION In the contemporary practice, an FFR-guided treatment strategy is associated with a favourable long-term outcome. The current study supports the use of the FFR for decision-making in patients undergoing cardiac catheterization.
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Affiliation(s)
- Jing Li
- Division of Cardiology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
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