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Affiliation(s)
- Ziad A Ali
- St. Francis Hospital, Roslyn, NY (Z.A.A.).,Cardiovascular Research Foundation, New York, NY (Z.A.A.)
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, United Kingdom (A.S.P.S.)
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2
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Rodríguez-Capitán J, Sánchez-Pérez A, Ballesteros-Pradas S, Millán-Gómez M, Cardenal-Piris R, Oneto-Fernández M, Gutiérrez-Alonso L, Rivera-López R, Guisado-Rasco A, Cano-García M, Gutiérrez-Bedmar M, Jiménez-Navarro M. Prognostic Implication of Non-Obstructive Coronary Lesions: A New Classification in Different Settings. J Clin Med 2021; 10:jcm10091863. [PMID: 33923110 PMCID: PMC8123418 DOI: 10.3390/jcm10091863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
The clinical significance of non-obstructive coronary artery disease is the subject of debate. Our objective was to evaluate the long-term cardiovascular prognosis associated with non-obstructive coronary artery disease in patients undergoing coronary angiography, and to conduct a stratification by sex, diabetes, and clinical indication. We designed a multi-centre retrospective longitudinal observational study of 3265 patients that were classified into three groups: normal coronary arteries (lesion <20%, 1426 patients), non-obstructive coronary artery disease (20–50%, 643 patients), and obstructive coronary artery disease (>70%, 1196 patients). During a mean follow-up of 43 months, we evaluated a combined cardiovascular event: acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Multivariable-adjusted Cox proportional hazard models showed a worse prognosis in patients with non-obstructive coronary artery disease, in comparison with patients of normal coronary arteries group, in the total population (hazard ratio 1.72, 95% confidence interval 1.23–2.39; p for trend <0.001), in non-diabetics (hazard ratio 2.12, 95% confidence interval: 1.40–3.22), in women (hazard ratio 1.75, 95% confidence interval 1.10–2.77), and after acute coronary syndrome (hazard ratio 2.07, 95% confidence interval 1.25–3.44). In conclusion, non-obstructive coronary artery disease is associated with an impaired long-term cardiovascular prognosis. This association held for non-diabetics, women, and after acute coronary syndrome.
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Affiliation(s)
- Jorge Rodríguez-Capitán
- Área del Corazón, UMA Campus de Teatinos S/N, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA, 29010 Málaga, Spain; (J.R.-C.); (A.S.-P.); (M.M.-G.)
| | - Andrés Sánchez-Pérez
- Área del Corazón, UMA Campus de Teatinos S/N, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA, 29010 Málaga, Spain; (J.R.-C.); (A.S.-P.); (M.M.-G.)
| | | | - Mercedes Millán-Gómez
- Área del Corazón, UMA Campus de Teatinos S/N, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA, 29010 Málaga, Spain; (J.R.-C.); (A.S.-P.); (M.M.-G.)
| | - Rosa Cardenal-Piris
- Hospital Universitario Juan Ramón Jiménez, Ronda Norte S/N, 21005 Huelva, Spain;
| | | | - Lola Gutiérrez-Alonso
- Hospital Universitario Puerta del Mar, Cádiz, Avenida Ana de Viya 21, 11009 Cádiz, Spain;
| | - Ricardo Rivera-López
- Servicio de Cardiología, Instituto de Investigación Biosanitaria (Ibs), Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain;
| | - Agustín Guisado-Rasco
- Hospital Universitario Virgen del Rocío, CIBERCV, Avenida Manuel Siurot S/N, 41013 Sevilla, Spain;
| | - Macarena Cano-García
- Hospital Regional Universitario de Málaga, Avenida de Carlos Haya 84, 29010 Málaga, Spain;
| | - Mario Gutiérrez-Bedmar
- Department of Preventive Medicine and Public Health, School of Medicine, Campus de Teatinos S/N, University of Málaga, 29010 Málaga, Spain
- Correspondence: (M.G.-B.); (M.J.-N.); Tel.: +34-952-137-387 (M.G.-B.); +34-951-032-054 (M.J.-N.)
| | - Manuel Jiménez-Navarro
- Área del Corazón, UMA Campus de Teatinos S/N, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA, 29010 Málaga, Spain; (J.R.-C.); (A.S.-P.); (M.M.-G.)
- Correspondence: (M.G.-B.); (M.J.-N.); Tel.: +34-952-137-387 (M.G.-B.); +34-951-032-054 (M.J.-N.)
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3
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Nogic J, Prosser H, O'Brien J, Thakur U, Soon K, Proimos G, Brown AJ. The assessment of intermediate coronary lesions using intracoronary imaging. Cardiovasc Diagn Ther 2020; 10:1445-1460. [PMID: 33224767 DOI: 10.21037/cdt-20-226] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intermediate coronary artery stenosis, defined as visual angiographic stenosis severity of between 30-70%, is present in up to one quarter of patients undergoing coronary angiography. Patients with this particular lesion subset represent a distinct clinical challenge, with operators often uncertain on the need for revascularization. Although international guidelines appropriately recommend physiological pressure-based assessment of these lesions utilizing either fractional flow reserve (FFR) or quantitative flow ratio (QFR), there are specific clinical scenarios and lesion subsets where the use of such indices may not be reliable. Intravascular imaging, mainly utilizing intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represents an alternate and at times complementary diagnostic modality for the evaluation of intermediate coronary stenoses. Studies have attempted to validate these specific imaging measures with physiological markers of lesion-specific ischaemia with varied results. Intravascular imaging however also provides additional benefits that include portrayal of plaque morphology, guidance on stent implantation and sizing and may portend improved clinical outcomes. Looking forward, research in computational fluid dynamics now seeks to integrate both lesion-based physiology and anatomical assessment using intravascular imaging. This review will discuss the rationale and indications for the use of intravascular imaging assessment of intermediate lesions, while highlighting the current limitations and benefits to this approach.
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Affiliation(s)
- Jason Nogic
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia.,Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Hamish Prosser
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Joseph O'Brien
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Kean Soon
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - George Proimos
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
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Lee JM, Lee SH, Hwang D, Rhee TM, Choi KH, Kim J, Park J, Kim HY, Jung HW, Cho YK, Yoon HJ, Song YB, Hahn JY, Nam CW, Shin ES, Doh JH, Hur SH, Koo BK. Long-Term Clinical Outcomes of Nonhyperemic Pressure Ratios: Resting Full-Cycle Ratio, Diastolic Pressure Ratio, and Instantaneous Wave-Free Ratio. J Am Heart Assoc 2020; 9:e016818. [PMID: 32914672 PMCID: PMC7726993 DOI: 10.1161/jaha.120.016818] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Nonhyperemic pressure ratios (NHPRs) such as instantaneous wave‐free ratio, resting full‐cycle ratio, or diastolic pressure ratio have emerged as invasive physiologic indices precluding the need for hyperemic agents. The current study sought to evaluate the long‐term prognostic implications of NHPRs compared with fractional flow reserve (FFR). Methods and Results NHPRs were calculated from resting pressure tracings by an independent core laboratory in 1024 vessels (435 patients). The association between NHPRs and the risk of 5‐year vessel‐oriented composite outcomes (VOCO, a composite of cardiac death, vessel‐related myocardial infarction, and ischemia‐driven revascularization) were analyzed among 864 deferred vessels. Lesions with positive NHPRs (instantaneous wave free ratio, resting full‐cycle ratio, and diastolic pressure ratio ≤0.89) or FFR (≤0.80) showed significantly higher risk of VOCO at 5 years than those with negative NHPRs or FFR, respectively. Discriminant ability for 5‐year VOCO was not different among NHPRs and FFR (C‐index: 0.623–0.641, P for comparison=0.215). In comparison of VOCO among the groups with deferred concordant negative (NHPRs−/FFR−), deferred discordant (NHPRs+/FFR− or NHPRs−/FFR+), and revascularized vessels, the cumulative incidence of VOCO were 7.5%, 14.4%, and 14.8% (log‐rank P<0.001), respectively. The deferred discordant group showed similar risk of VOCO with the revascularized vessel group (hazard ratio, 0.981; 95% CI 0.434–2.217, P=0.964). Conclusions Currently available invasive pressure‐derived indices showed similar prognostic implications for vessel‐related events at 5 years. Deferred lesions with discordant results between NHPRs and FFR did not show higher risk of vessel‐related events at 5 years than revascularized vessels. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01621438, NCT01621438.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Seung Hun Lee
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Tae-Min Rhee
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Ki Hong Choi
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Jinseob Kim
- Department of Epidemiology School of Public Health Seoul National University Seoul South Korea
| | - Jinhyoung Park
- Department of Biomedical Engineering Sungkyunkwan University Suwon Gyeonggi-do South Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine Chonnam National University Hospital Gwangju South Korea
| | - Hae Won Jung
- Department of Cardiology Daegu Catholic University Medical Center Daegu South Korea
| | - Yun-Kyeong Cho
- Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea
| | - Hyuck-Jun Yoon
- Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea
| | - Young Bin Song
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Joo-Yong Hahn
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Chang-Wook Nam
- Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea
| | - Eun-Seok Shin
- Division of Cardiology Ulsan Medical Center Ulsan South Korea
| | - Joon-Hyung Doh
- Department of Medicine Inje University Ilsan Paik Hospital Goyang South Korea
| | - Seung-Ho Hur
- Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul South Korea.,Institute on Aging Seoul National University Seoul South Korea
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