1
|
Lee SY, Choi KH, Kim CJ, Lee JM, Song YB, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Kim SE, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY. Impact of Intravascular Imaging-Guided Stent Optimization According to Clinical Presentation in Patients Undergoing Complex PCI. JACC Cardiovasc Interv 2024; 17:1231-1243. [PMID: 38811104 DOI: 10.1016/j.jcin.2024.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND It is unclear whether the beneficial effects of intravascular imaging-guided stent optimization vary by clinical presentation during complex percutaneous coronary intervention (PCI). OBJECTIVES In this prespecified, stratified subgroup analysis from RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance versus Angiography-Guidance on Clinical Outcomes After Complex PCI), we sought to compare the outcomes between intravascular imaging vs angiography guidance according to clinical presentation. METHODS Patients with complex coronary artery lesions were randomly assigned to undergo either intravascular imaging-guided PCI or angiography-guided PCI in a 2:1 ratio. The primary endpoint was target vessel failure (TVF), which is a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization. RESULTS Of 1,639 patients, 832 (50.8%) presented with acute coronary syndrome (ACS) and 807 (49.2%) with chronic coronary syndrome. During a median follow-up of 2.1 years (Q1-Q3: 1.4-3.0 years), there was no significant interaction between the treatment effect of intravascular imaging and clinical presentation (P for interaction = 0.19). Among patients with ACS, the incidences of TVF were 10.4% in the intravascular imaging group and 14.6% in the angiography group (HR: 0.74; 95% CI: 0.48-1.15; P = 0.18). Among patients with CCS, the incidences of TVF were 5.0% in the intravascular imaging group and 10.4% in the angiography group (HR: 0.46; 95% CI: 0.27-0.80; P = 0.006). Achieving stent optimization by intravascular imaging resulted in a reduced risk of TVF among patients with ACS who were randomly assigned to intravascular imaging-guided PCI for complex coronary lesions (optimized vs unoptimized, 6.5% vs 14.1%; HR: 0.49; 95% CI: 0.27-0.87; P = 0.02) but not those with CCS (5.4% vs 4.7%, HR: 1.18; 95% CI: 0.53-2.59; P = 0.69). CONCLUSIONS No significant interaction was observed between the benefits of intravascular imaging and clinical presentation in the risk of TVF. Stent optimization by intravascular imaging was particularly important for ACS patients. (Intravascular Imaging- Versus Angiography-Guided Percutaneous Coronary Intervention For Complex Coronary Artery Disease [RENOVATE]; NCT03381872).
Collapse
Affiliation(s)
- Sang Yoon Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea.
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea; Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | | | | | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea
| | | | | | - Yong Hwan Park
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Pil Sang Song
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sung Eun Kim
- Inje University Ilsan Paik Hospital, Goyang, Korea
| | | | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chang-Hwan Yoon
- Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Kwan Yong Lee
- The Catholic University of Korea, Incheon St. Mary's Hospital, Seoul, Korea
| | - Young-Hyo Lim
- Hanyang University Seoul Hospital, College of Medicine, Hanyang University, Seoul, Korea
| | | | - Jin-Man Cho
- Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Woo Jin Jang
- Ewha Womans University College of Medicine, Seoul, Korea
| | - Kook-Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, Korea
| | - David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Zhang Y, Yang B, Ye Y, Zhao X, Ding Y, Ye Y, Zhang L, Tan D, Zhang G, Duan X, Li Q, Zeng Y. Prognostic significance of compliance with fractional flow reserve guidance on diverse vessel-related clinical outcomes. Front Cardiovasc Med 2024; 11:1370345. [PMID: 38826819 PMCID: PMC11140391 DOI: 10.3389/fcvm.2024.1370345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
Background In patients underwent fractional flow reserve (FFR) assessment, a noteworthy proportion of adverse events occur in vessels in which FFR has not been measured. However, the effect of these non-target vessel-related events on the evaluation of FFR-related benefits remains unknown. Methods and results In this retrospective study, vessels subjected to FFR measurement were grouped as FFR-based approach and non-compliance with FFR based on whether they received FFR-based treatment. Using inverse probability of treatment weighting (IPTW) to account for potential confounding, we investigated the association between compliance with FFR and 5-year target vessel failure (TVF) non-target vessel failure (NTVF) and vessel-oriented composite endpoints (VOCEs). Of the 1,119 vessels, 201 did not receive FFR-based treatment. After IPTW adjustment, a significantly lower hazard of TVF was observed in the FFR-based approach group (HR: 0.56; 95% CI: 0.34-0.92). While, the intergroup difference in hazard of NTVF (HR: 1.02; 95% CI: 0.45-2.31) and VOCEs (HR: 0.69; 95% CI: 0.45-1.05) were nonsignificant. Conclusions In patients with CAD subjected to FFR, the FFR-based treatment yields a sustained clinical benefit in terms of the risks of target vessel-related events. The dilution of non-target vessel-related events renders the difference favoring the FFR-based approach nonsignificant.
Collapse
Affiliation(s)
- Yang Zhang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bangguo Yang
- Department of Cardiology, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Yicong Ye
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiliang Zhao
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yaodong Ding
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Ye
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Liang Zhang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dawei Tan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Gong Zhang
- Division of Cardiology, Beijing Daxing District People’s Hospital, Beijing, China
| | - Xiaoyu Duan
- General Medicine Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan Li
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yong Zeng
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Faro DC, Laudani C, Agnello FG, Ammirabile N, Finocchiaro S, Legnazzi M, Mauro MS, Mazzone PM, Occhipinti G, Rochira C, Scalia L, Spagnolo M, Greco A, Capodanno D. Complete Percutaneous Coronary Revascularization in Acute Coronary Syndromes With Multivessel Coronary Disease: A Systematic Review. JACC Cardiovasc Interv 2023; 16:2347-2364. [PMID: 37821180 DOI: 10.1016/j.jcin.2023.07.043] [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: 04/02/2023] [Revised: 06/06/2023] [Accepted: 07/18/2023] [Indexed: 10/13/2023]
Abstract
Multivessel disease (MVD) affects approximately 50% of patients with acute coronary syndromes (ACS) and is significantly burdened by poor outcomes and high mortality. It represents a clinical challenge in patient management and decision making and subtends an evolving research area related to the pathophysiology of unstable plaques and local or systemic inflammation. The benefits of complete revascularization are established in hemodynamically stable ACS patients with MVD, and guidelines provide some reference points to inform clinical practice, based on an evidence level that is solid for ST-segment elevation myocardial infarction and less robust for non-ST-segment elevation myocardial infarction and cardiogenic shock. However, several areas of uncertainty remain, such as the optimal timing for complete revascularization or the best guiding strategy for intermediate stenoses. We performed a systematic review of current evidence in the field of percutaneous revascularization in ACS and MVD, also including future perspectives from ongoing trials that will directly compare different timing strategies and investigate the role of invasive and noninvasive guidance techniques. (Complete percutaneous coronary revascularization in patients with acute myocardial infarction and multivessel disease; CRD42022383123).
Collapse
Affiliation(s)
- Denise Cristiana Faro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Federica Giuseppa Agnello
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Nicola Ammirabile
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Simone Finocchiaro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Marco Legnazzi
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Maria Sara Mauro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Placido Maria Mazzone
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Giovanni Occhipinti
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Carla Rochira
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Lorenzo Scalia
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Marco Spagnolo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Antonio Greco
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy.
| |
Collapse
|
4
|
Berntorp K, Rylance R, Yndigegn T, Koul S, Fröbert O, Christiansen EH, Erlinge D, Götberg M. Clinical Outcome of Revascularization Deferral With Instantaneous Wave-Free Ratio and Fractional Flow Reserve: A 5-Year Follow-Up Substudy From the iFR-SWEDEHEART Trial. J Am Heart Assoc 2023; 12:e028423. [PMID: 36734349 PMCID: PMC9973641 DOI: 10.1161/jaha.122.028423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Although physiology-based assessment of coronary artery stenosis using instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) are established methods of guiding coronary revascularization, its clinical outcome in long-term deferral needs further evaluation, especially with acute coronary syndrome as a clinical presentation. The aim was to evaluate the long-term clinical outcome of deferral of revascularization based on iFR or FFR. Methods and Results This is a substudy of the iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trial, where patients deferred from revascularization from each study arm were selected. Nine hundred eight patients deferred from coronary revascularization with iFR (n=473) and FFR (n=435) were followed for 5 years. The national quality registry, SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies), was used for patient data collection and clinical follow-up. The end point was major adverse cardiac events and their individual components all-cause death, cardiovascular death, noncardiovascular death, nonfatal myocardial infarction, and unplanned revascularization. No significant difference was found in major adverse cardiac events (iFR 18.6% versus FFR 16.8%; adjusted hazard ratio, 1.08 [95% CI, 0.79-1.48]; P=0.63) or their individual components. Conclusions No differences in clinical outcomes after 5-year follow-up were noted when comparing iFR versus FFR as methods for deferral of coronary revascularization in patients presenting with stable angina pectoris and acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02166736.
Collapse
Affiliation(s)
- Karolina Berntorp
- Department of CardiologySkåne University Hospital, Clinical Sciences, Lund UniversityLundSweden
| | - Rebecca Rylance
- Department of CardiologySkåne University Hospital, Clinical Sciences, Lund UniversityLundSweden
| | - Troels Yndigegn
- Department of CardiologySkåne University Hospital, Clinical Sciences, Lund UniversityLundSweden
| | - Sasha Koul
- Department of CardiologySkåne University Hospital, Clinical Sciences, Lund UniversityLundSweden
| | - Ole Fröbert
- Faculty of Health, Department of CardiologyÖrebro University HospitalÖrebroSweden
| | | | - David Erlinge
- Department of CardiologySkåne University Hospital, Clinical Sciences, Lund UniversityLundSweden
| | - Matthias Götberg
- Department of CardiologySkåne University Hospital, Clinical Sciences, Lund UniversityLundSweden
| |
Collapse
|
5
|
Okuya Y, Gohil K, Moussa ID. Angiography versus FFR guided complete revascularization versus culprit-only revascularization for patients presenting with STEMI: Network meta-analysis. Catheter Cardiovasc Interv 2022; 100:340-350. [PMID: 35789058 DOI: 10.1002/ccd.30304] [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: 01/07/2022] [Revised: 04/17/2022] [Accepted: 06/05/2022] [Indexed: 11/07/2022]
Abstract
This study aimed to compare the outcomes of different revascularization strategies among patients presenting with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) undergoing primary percutaneous coronary intervention (PCI). MVD is present in about one-half of patients presenting with STEMI. Despite several randomized controlled trials (RCTs) comparing complete revascularization (CR) and culprit-only revascularization (COR), the optimal PCI strategy for STEMI patients with MVD remains unsettled. Moreover, it is unclear whether angiography-guided CR or fractional flow reserve (FFR)-guided CR is associated with better outcomes. PubMed, Scopus, and Cochrane Library were searched for RCTs comparing CR strategies with COR strategy in patients with STEMI between January 1, 2000 and September 30, 2021 were identified. A frequentist network meta-analyses were performed for three PCI strategies: (1) COR; (2) angiography-guided CR; and (3) FFR-guided CR. Ten RCTs including 7979 patients were included. A strategy of angiography-guided CR or FFR-guided CR was associated with a significantly lower rate of major adverse cardiac events (MACE) and unplanned revascularization compared with COR. Although there were no statistical significant difference between angiography-guided CR and FFR-guided CR, P score analysis showed that angiography-guided CR was ranked as the best strategy for reducing MACE, all-cause mortality, cardiovascular death, recurrent myocardial infarction, and unplanned revascularization. In patients presenting with STEMI and MVD undergoing primary PCI, angiography-guided CR or FFR-guided CR improve outcomes compared with COR. Furthermore, the strategy of angiography-guided CR ranked as the best revascularization strategy in those patients.
Collapse
Affiliation(s)
- Yoshiyuki Okuya
- Department of Clinical Sciences, Heart and Vascular Institute, Carle Health, Urbana, Illinois, USA.,Department of Clinical Sciences, Carle Illinois College of Medicine, University of Illinois, Urbana, Illinois, USA
| | - Kavita Gohil
- Department of Clinical Sciences, Stephens Family Clinical Research Institute, Carle Health, Urbana, Illinois, USA
| | - Issam D Moussa
- Department of Clinical Sciences, Heart and Vascular Institute, Carle Health, Urbana, Illinois, USA.,Department of Clinical Sciences, Carle Illinois College of Medicine, University of Illinois, Urbana, Illinois, USA
| |
Collapse
|
6
|
Hidalgo F, Gonzalez-Manzanares R, Ojeda S, Benito-González T, Gutiérrez-Barrios A, De la Torre Hernández JM, Minguito-Carazo C, Izaga-Torralba E, Cabrera-Rubio I, Flores-Vergara G, de Lezo JS, Romero-Moreno M, de Prado AP, Pan M. Instantaneous wave-free ratio for guiding treatment of nonculprit lesions in patients with acute coronary syndrome: A retrospective study. Catheter Cardiovasc Interv 2021; 99:489-496. [PMID: 34862839 DOI: 10.1002/ccd.30025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/25/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to analyze the feasibility of a physiological coronary evaluation with the instantaneous wave-free ratio (iFR) of nonculprit lesions in patients with acute coronary syndrome (ACS) successfully revascularized. METHODS A multicenter registry including patients of four high-volume PCI centers with ACS and underwent successful revascularization of the culprit vessel and had other nonculprit lesions that were physiologically evaluated with the iFR between January 2017 and December 2019. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, probable or definitive stent thrombosis and new revascularization (MACEs). RESULTS A total of 356 patients with 472 nonculprit lesions were included. The mean age was 66 ± 11 years. The clinical presentation was ACS without persistent ST-segment elevation (NSTE-ACS) in 235 patients (66%) and ST-segment elevation myocardial infarction (STEMI) in 121 patients (34%). After a median follow-up period of 21 (14-30) months, the primary endpoint occurred in 32 patients (9%). There were no differences in outcomes regarding clinical presentation (NSTEMI vs. NSTE-ACS, 9.1 vs. 8.9%, padj = 0.570) or iFR induced treatment strategy (patients with all lesions revascularized vs. patients with at least one lesion with an iFR > 0.89 deferred for revascularization, 10.5 vs. 8.4%, padj = 0.476). CONCLUSIONS The use of the iFR to guide percutaneous coronary intervention decision making in nonculprit lesions seems to be feasible, with an acceptable percentage of MACEs at the mid-term follow-up. Patients with deferred revascularization of lesions without physiological significance and patients undergoing complete revascularization had a similar risk of MACEs.
Collapse
Affiliation(s)
- Francisco Hidalgo
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Rafael Gonzalez-Manzanares
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Soledad Ojeda
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Tomás Benito-González
- Interventional Cardiology Unit, Department of Cardiology, University Hospital of León, León, Spain
| | | | | | - Carlos Minguito-Carazo
- Interventional Cardiology Unit, Department of Cardiology, University Hospital of León, León, Spain
| | | | - Indira Cabrera-Rubio
- Department of Cardiology, IDIVAL, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Guisela Flores-Vergara
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Javier Suárez de Lezo
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Miguel Romero-Moreno
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Armando Pérez de Prado
- Interventional Cardiology Unit, Department of Cardiology, University Hospital of León, León, Spain
| | - Manuel Pan
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| |
Collapse
|
7
|
Milzi A, Dettori R, Marx N, Reith S, Burgmaier M. Quantitative flow ratio (QFR) identifies functional relevance of non-culprit lesions in coronary angiographies of patients with acute myocardial infarction. Clin Res Cardiol 2021; 110:1659-1667. [PMID: 34251507 PMCID: PMC8484103 DOI: 10.1007/s00392-021-01897-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In patients with acute myocardial infarction (AMI) and multivessel coronary disease, revascularization of non-culprit lesions guided by proof of ischemia usually requires staged ischemia testing. Quantitative flow ratio (QFR) has been shown to be effective in assessing the hemodynamic relevance of lesions in stable coronary disease. However, its suitability in AMI patients is unknown. In this study, we tested the diagnostic value of QFR based on acute angiograms (aQFR) during AMI to assess the hemodynamic relevance of non-culprit lesions. METHODS We retrospectively assessed the diagnostic efficiency of aQFR in 280 vessels from 220 patients, comparing it with staged ischemia testing using elective coronary angiography with FFR (n = 47), stress cardiac MRI (n = 200) or SPECT (n = 33). RESULTS aQFR showed a very good diagnostic efficiency (AUC = 0.887, 95% CI 0.832-0.943, p < 0.001) in predicting ischemia of non-culprit lesions, significantly superior to coronary lesion's geometry as assessed by quantitative coronary angiography. The optimal cut-off for aQFR to predict ischemia was 0.80 (sensitivity = 83.7%, specificity = 86.1%). Maintaining a predefined level of 95% sensitivity and specificity, we created a decision model based on aQFR: lesions with aQFR ≤ 0.75 should be treated, lesions with aQFR ≥ 0.92 do not yield any hemodynamic relevance, and lesions in the "grey zone" (aQFR 0.75-0.92) benefit from further ischemia testings. This model would allow to reduce staged ischemia tests by 46.8% without a relevant loss in diagnostic efficiency. CONCLUSION Our data demonstrate that aQFR allows an effective assessment of hemodynamic relevance of non-culprit lesions in AMI and may guide interventions of non-culprit coronary lesions.
Collapse
Affiliation(s)
- Andrea Milzi
- Department of Cardiology, University Hospital, RWTH Aachen University, Aachen, Germany.
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Rosalia Dettori
- Department of Cardiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Sebastian Reith
- Department of Cardiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Mathias Burgmaier
- Department of Cardiology, University Hospital, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
8
|
Ahres A, Jablonkai B, Schrancz Á, Balogh Z, Kenessey A, Baranyai T, Őze Á, Szigeti Z, Rubóczky G, Nagybaczoni B, Apor A, Simon J, Szilveszter B, Kolossváry M, Merkely B, Maurovich-Horvat P, Andrássy P. Patients with Moderate Non-Culprit Coronary Lesions of Recent Acute Coronary Syndrome. Int Heart J 2021; 62:952-961. [PMID: 34497167 DOI: 10.1536/ihj.20-760] [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] [Indexed: 11/18/2022]
Abstract
Fractional flow reserve (FFR) measurement was compared to dobutamine stress echocardiography (DSE) instable angina (SA) with stable coronary lesion (s) (SCL (s) ) in a few trials; however, similar comparisons in patients with acute coronary syndrome (ACS) with non-culprit lesion (s) (NCL (s) ) are lacking. Our objectives were to prospectively evaluate the diagnostic performance of FFR with two different cutoff values (< 0.80 and < 0.75) relative to DSE in moderate (30%-70% diameter stenosis) NCLs (ACS group) and to compare these observations with those measured in SCLs (SA group). One hundred seventy-five consecutive patients with SA (n = 86) and ACS (n = 89) with 225 coronary lesions (109 SCLs and 116 NCLs) were enrolled. In contrast to the ACS cohort in SA patients, normal DSE was associated with higher FFR values compared to those with abnormal DSE (P = 0.051 versus P = 0.006). In addition, in the SA group, a significant correlation was observed between DSE (regional wall motion score index at peak stress) and FFR (r = -0.290; P = 0.002), whereas a similar association was absent (r = -0.029; P = 0.760) among ACS patients. In the SA group, decreasing the FFR cutoff value (< 0.80 versus < 0.75) improved the concordance of FFR with DSE (70.6% versus 81.7%) without altering its discriminatory power (area under the curve; 0.68 versus 0.63; P = 0.369), whereas in the ACS group, concordance remained similar (69.0% versus 71.6%) and discriminatory power decreased (0.62 versus 0.51; P = 0.049), respectively. In conclusion, lesion-specific FFR assessment may have different relevance in patients with moderate NCLs than in patients with SCLs.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ágnes Őze
- Department of Cardiology, Bajcsy-Zsilinszky Hospital
| | - Zsolt Szigeti
- Department of Cardiology, Bajcsy-Zsilinszky Hospital
| | | | | | - Astrid Apor
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University
| | - Judit Simon
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University
| | - Bálint Szilveszter
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University
| | - Márton Kolossváry
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University
| | - Béla Merkely
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University
| | - Pál Maurovich-Horvat
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University.,Medical Imaging Center, Semmelweis University
| | | |
Collapse
|
9
|
Denormandie P, Simon T, Cayla G, Steg PG, Montalescot G, Durand-Zaleski I, Le Bras A, Le Breton H, Valy Y, Schiele F, Cuisset T, Vanzetto G, Levesque S, Goube P, Nallet O, Angoulvant D, Roubille F, Charles-Nelson A, Chatellier G, Danchin N, Puymirat E. Compared Outcomes of ST-Elevation Myocardial Infarction Patients with Multivessel Disease Treated with Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Non-Culprit Lesions Treated Conservatively and of Those with Low Fractional Flow Reserve Managed Invasively: Insights from the FLOWER MI trial. Circ Cardiovasc Interv 2021; 14:e011314. [PMID: 34420366 DOI: 10.1161/circinterventions.121.011314] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In patients with ST-elevation myocardial infarction (STEMI) and multivessel disease, percutaneous coronary intervention (PCI) for non-culprit lesions guided by FFR is superior to treatment of the culprit lesion alone. Whether deferring non-culprit PCI is safe in this specific context is questionable. We aimed to assess clinical outcomes at one-year in STEMI patients with multivessel coronary artery disease and an FFR-guided strategy for non-culprit lesions, according to whether or not ≥1 PCI was performed. Methods: Outcomes were analyzed in patients of the randomized FLOWER MI (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) trial in whom, after successful primary PCI, non-culprit lesions were assessed using FFR. The primary outcome was a composite of all-cause death, non-fatal MI, and unplanned hospitalization with urgent revascularization at one year. Results: Among 1,171 patients enrolled in this study, 586 were assigned to the FFR-guided group: 388 (66%) of them had ≥1 PCI and 198 (34%) had no PCI. Mean FFR before decision (i.e., PCI or not) of non-culprit lesions were 0.75±0.10 and 0.88±0.06, respectively. During follow-up, a primary outcome event occurred in 16 of 388 patients (4.1%) in patients with PCI and in 16 of 198 patients (8.1%) in patients without PCI (adjusted hazard ratio, 0.42; 95% confidence interval, 0.20 to 0.88; P = 0.02). Conclusions: In patients with STEMI undergoing complete revascularization guided by FFR measurement, those with ≥1 PCI had lower event rates at 1 year, compared with patients with deferred PCI, suggesting that deferring lesions judged relevant by visual estimation but with FFR >0.80 may not be optimal in this context. Future randomized studies are needed to confirm this data.
Collapse
Affiliation(s)
- Pierre Denormandie
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France
| | - Tabassome Simon
- AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Université Pierre et Marie Curie (UPMC-Paris 06), INSERM U-698, Paris, France; French Alliance for Cardiovascular Trials (FACT)
| | - Guillaume Cayla
- Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Trials (FACT); Université de Paris, INSERM Unité-1148, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study group, Institut de Cardiologie (APHP), INSERM UMRS 1166, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Alicia Le Bras
- Clinical Research Unit Eco Ile de France, Hôpital Hôtel Dieu, AP-HP, Paris, France
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | - Yann Valy
- Department of Cardiology, CH Saint-Louis, La Rochelle, France
| | - François Schiele
- French Alliance for Cardiovascular Trials (FACT); Department of Cardiology, University Hospital Besançon, Besançon, France, EA 3920 University of Burgundy Franche-Comté, Besançon, France
| | - Thomas Cuisset
- ACTION Study Group, Cardiology Department, INSERM UMR1062, INRA UMR1260, Centre Hospitalier Universitaire La Timone, Aix-Marseille University, Marseille, France
| | - Gérald Vanzetto
- French Alliance for Cardiovascular Trials (FACT); Department of Cardiology, University Hospital, 38000 Grenoble Alpes, France, INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble Alpes University, 38000 Grenoble Alpes, France
| | - Sébastien Levesque
- Cardiovascular Interventional Unit, Division of Cardiology, Department of Medicine, Centre Cardio-Vasculaire, CHU de Poitiers, Poitiers, France
| | - Pascal Goube
- Department of Cardiology, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Olivier Nallet
- Cardiology Department, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - Denis Angoulvant
- Cardiology Department and EA4245 T2i, University Hospital of Tours and Tours University, 37000 Tours, France
| | - François Roubille
- Department of Cardiology, Regional University Hospital of Montpellier, Montpellier, France, PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Anaïs Charles-Nelson
- Clinical Research Unit and CIC 1418 INSERM, George-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Gilles Chatellier
- Clinical Research Unit and CIC 1418 INSERM, George-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France; AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Université Pierre et Marie Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France; AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Université Pierre et Marie Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| |
Collapse
|
10
|
Paradies V, Waldeyer C, Laforgia PL, Clemmensen P, Smits PC. Completeness of revascularisation in acute coronary syndrome patients with multivessel disease. EUROINTERVENTION 2021; 17:193-201. [PMID: 34167938 PMCID: PMC9725070 DOI: 10.4244/eij-d-20-00957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/23/2022]
Abstract
A significant proportion of patients presenting with acute coronary syndromes (ACS) have multivessel disease (MVD). Despite the abundance of clinical trials in this area, several questions regarding the procedure of complete coronary revascularisation remain unanswered. This state-of-the-art review summarises the latest evidence on complete revascularisation (CR) in this subset of patients and critically appraises clinical decision making based on non-culprit lesion (NCL) assessment. Future areas of research are put into perspective.
Collapse
Affiliation(s)
- Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | | | | | | | | |
Collapse
|
11
|
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GC. Guía ESC 2020 sobre el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1289-1367. [PMID: 32860058 DOI: 10.1093/eurheartj/ehaa575] [Citation(s) in RCA: 2739] [Impact Index Per Article: 913.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
13
|
Haley HA, Ghobrial M, Morris PD, Gosling R, Williams G, Mills MT, Newman T, Rammohan V, Pederzani G, Lawford PV, Hose R, Gunn JP. Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes. Front Cardiovasc Med 2021; 8:735008. [PMID: 34746253 PMCID: PMC8569111 DOI: 10.3389/fcvm.2021.735008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022] Open
Abstract
The current management of acute coronary syndromes (ACS) is with an invasive strategy to guide treatment. However, identifying the lesions which are physiologically significant can be challenging. Non-invasive imaging is generally not appropriate or timely in the acute setting, so the decision is generally based upon visual assessment of the angiogram, supplemented in a small minority by invasive pressure wire studies using fractional flow reserve (FFR) or related indices. Whilst pressure wire usage is slowly increasing, it is not feasible in many vessels, patients and situations. Limited evidence for the use of FFR in non-ST elevation (NSTE) ACS suggests a 25% change in management, compared with traditional assessment, with a shift from more to less extensive revascularisation. Virtual (computed) FFR (vFFR), which uses a 3D model of the coronary arteries constructed from the invasive angiogram, and application of the physical laws of fluid flow, has the potential to be used more widely in this situation. It is less invasive, fast and can be integrated into catheter laboratory software. For severe lesions, or mild disease, it is probably not required, but it could improve the management of moderate disease in 'real time' for patients with non-ST elevation acute coronary syndromes (NSTE-ACS), and in bystander disease in ST elevation myocardial infarction. Its practicability and impact in the acute setting need to be tested, but the underpinning science and potential benefits for rapid and streamlined decision-making are enticing.
Collapse
Affiliation(s)
- Hazel Arfah Haley
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Mina Ghobrial
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Paul D. Morris
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Rebecca Gosling
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Gareth Williams
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Mark T. Mills
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Tom Newman
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Vignesh Rammohan
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Giulia Pederzani
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Patricia V. Lawford
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Rodney Hose
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
| | - Julian P. Gunn
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for in silico Medicine, Sheffield, United Kingdom
- Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
- *Correspondence: Julian P. Gunn
| |
Collapse
|
14
|
Cerrato E, Mejía-Rentería H, Dehbi HM, Ahn JM, Cook C, Dupouy P, Baptista SB, Raposo L, Van Belle E, Götberg M, Davies JE, Park SJ, Escaned J. Revascularization Deferral of Nonculprit Stenoses on the Basis of Fractional Flow Reserve. JACC Cardiovasc Interv 2020; 13:1894-1903. [DOI: 10.1016/j.jcin.2020.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/16/2020] [Accepted: 05/12/2020] [Indexed: 01/26/2023]
|
15
|
Tovar Forero MN, Scarparo P, den Dekker W, Balbi M, Masdjedi K, van Zandvoort L, Kardys I, Ameloot K, Daemen J, Lemmert M, Wilschut J, de Jaegere P, Zijlstra F, Van Mieghem N, Diletti R. Revascularization Strategies in Patients Presenting With ST-Elevation Myocardial Infarction and Multivessel Coronary Disease. Am J Cardiol 2020; 125:1486-1491. [PMID: 32200948 DOI: 10.1016/j.amjcard.2020.01.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/26/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
The optimal revascularization strategy for residual coronary stenosis following primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) remains controversial. This is a retrospective single-centre study including patients with STEMI and MVD. Based on the revascularization strategy, 3 groups were identified: (1) culprit only (CO), (2) ad hoc multivessel revascularization (MVR), and (3) staged MVR. Clinical outcomes were compared in terms of major adverse cardiac events (MACE), a composite of cardiac death, any myocardial infarction, and any unplanned revascularization at a long-term follow-up. A total of 958 patients were evaluated, 489 in the CO, 254 in the ad hoc, and 215 in the staged group. In the staged group, 65.6% of the patients received planned percutaneous coronary intervention, 9.7% coronary artery bypass grafting, 8.4% no further intervention after lesion reassessment, and in 16.3% an event occurred before the planned procedure. At 1,095 days, MACE was 36.1%, 16.7%, and 31% for CO, ad hoc, and staged groups, respectively. A MVR strategy was associated with lower rate of all-cause death compared with CO (HR 0.50; 95%CI [0.31 to 0.80]; p = 0.004). Complete revascularization reduced the rate of MACE (HR 0.30 [0.21 to 0.43] p < 0.001) compared with incomplete revascularization. Ad hoc MVR had lower rate of MACE compared with staged MVR (HR 0.61 [0.39 to 0.96] p = 0.032) mainly driven by less unplanned revascularizations. In conclusion, in patients with STEMI and MVD, complete revascularization reduced the risk of MACE. Ad hoc MVR appeared a reasonable strategy with lower contrast and stent usage and costs.
Collapse
Affiliation(s)
| | - Paola Scarparo
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand den Dekker
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Matthew Balbi
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kaneshka Masdjedi
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Laurens van Zandvoort
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Koen Ameloot
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Miguel Lemmert
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Peter de Jaegere
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| |
Collapse
|
16
|
Choi KH, Song YB, Lee JM, Park TK, Yang JH, Choi JH, Choi SH, Oh JH, Cho DK, Lee JB, Doh JH, Kim SH, Jeong JO, Bae JH, Kim BO, Cho JH, Suh IW, Kim DI, Park HK, Park JS, Choi WG, Lee WS, Gwon HC, Hahn JY. Clinical Usefulness of PRECISE-DAPT Score for Predicting Bleeding Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: An Analysis From the SMART-DATE Randomized Trial. Circ Cardiovasc Interv 2020; 13:e008530. [PMID: 32354228 DOI: 10.1161/circinterventions.119.008530] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the current guidelines endorse the PRECISE-DAPT score (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy) to inform clinical decisions regarding duration of DAPT in patients undergoing percutaneous coronary intervention, use of the PRECISE-DAPT score to guide duration of DAPT has not been properly validated by randomized trials focused on the population with acute coronary syndrome. This study aimed to evaluate the usefulness of the PRECISE-DAPT score for predicting future bleeding and ischemic events and to compare clinical outcomes of short-term and long-term DAPT duration according to the PRECISE-DAPT score in patients with acute coronary syndrome. METHODS This was a substudy of the SMART-DATE trial (6- Versus 12-Month or Longer Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome), in which patients with acute coronary syndrome undergoing percutaneous coronary intervention were randomly assigned to either 6- (n=1357) or 12-month or longer DAPT (n=1355). Major bleeding (Bleeding Academic Research Consortium type 3-5) and ischemic (myocardial infarction, stent thrombosis, or ischemic stroke) events at 18 months after the index procedure were compared between the 6- and 12-month or longer DAPT groups, according to PRECISE-DAPT score. RESULTS The PRECISE-DAPT score was moderately effective at predicting bleeding events (area under the curve, 0.754 [95% CI, 0.655-0.854]; P<0.001). In patients with nonhigh PRECISE-DAPT score (<25, n=1967 [72.5%]), 6-month DAPT was associated with higher ischemic risk (2.7% versus 1.3%; HR, 2.01 [95% CI, 1.03-3.91]; P=0.040; absolute risk difference, +1.3%; P=0.035) with similar bleeding risk (0.4% versus 0.3%; HR, 2.00 [95% CI, 0.37-10.94]; P=0.422; absolute risk difference, +0.2%; P=0.498), compared with 12-month or longer DAPT. Among patients with high PRECISE-DAPT score (≥25, n=745 [27.5%]), 6-month DAPT presented a similar ischemic risk (4.8% versus 3.4%; HR, 1.43 [95% CI, 0.68-2.98], P=0.348; absolute risk difference, +1.5%; P=0.327) but significantly reduced major bleeding risk (0.6% versus 2.3%; HR, 0.25 [95% CI, 0.05-1.17]; P=0.079; absolute risk difference, -1.7%; P=0.045). CONCLUSIONS Consistent with current guidelines, determination of the duration of DAPT according to PRECISE-DAPT score could improve the clinical outcomes in patients with acute coronary syndrome after percutaneous coronary intervention with current-generation drug-eluting stents. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01701453.
Collapse
Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-H.C., S.-H.C., H.-C.G., J.-Y.H.)
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-H.C., S.-H.C., H.-C.G., J.-Y.H.)
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-H.C., S.-H.C., H.-C.G., J.-Y.H.)
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-H.C., S.-H.C., H.-C.G., J.-Y.H.)
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-H.C., S.-H.C., H.-C.G., J.-Y.H.)
| | - Jin-Ho Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-H.C., S.-H.C., H.-C.G., J.-Y.H.)
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-H.C., S.-H.C., H.-C.G., J.-Y.H.)
| | - Ju-Hyeon Oh
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Korea (J.-H.O.)
| | - Deok-Kyu Cho
- Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Goyang, Korea (D.-K.C.)
| | - Jin Bae Lee
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Korea (J.B.L.)
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.)
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea (S.-H.K.)
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea (J.-O.J.)
| | - Jang-Ho Bae
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejon, Korea (J.-H.B.)
| | - Byung-Ok Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea (B.-O.K.)
| | - Jang Hyun Cho
- Division of Cardiology, Department of Internal Medicine, St. Carollo General Hospital, Suncheon, Korea (J.H.C.)
| | - Il-Woo Suh
- Division of Cardiology, Department of Internal Medicine, SAM Medical Center, Anyang, Korea (I.-W.S.)
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea (D.-i.K.)
| | - Hoon-Ki Park
- Division of Cardiology, Department of Internal Medicine, Seoul Veterans Hospital, Korea (H.-K.P.)
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea (J.-S.P.)
| | - Woong Gil Choi
- Division of Cardiology, Department of Internal Medicine, Chungju Konkuk University Medical Center, Korea (W.G.C.)
| | - Wang Soo Lee
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea (W.S.L.)
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-H.C., S.-H.C., H.-C.G., J.-Y.H.)
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-H.C., S.-H.C., H.-C.G., J.-Y.H.)
| |
Collapse
|
17
|
Piróth Z, Boxma-de Klerk BM, Omerovic E, Andréka P, Fontos G, Fülöp G, Abdel-Wahab M, Neumann FJ, Richardt G, Abdelghani M, Smits PC. The Natural History of Nonculprit Lesions in STEMI. JACC Cardiovasc Interv 2020; 13:954-961. [DOI: 10.1016/j.jcin.2020.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
|
18
|
Weerts J, Pustjens T, Amin E, Ilhan M, Veenstra LF, Theunissen RALJ, Vainer J, Stein M, Ruiters LAW, Gho BCG, Van't Hof AWJ, Rasoul S. Long-term outcome after deferred revascularization due to negative fractional flow reserve in intermediate coronary lesions. Catheter Cardiovasc Interv 2020; 97:247-256. [PMID: 31999077 PMCID: PMC7983981 DOI: 10.1002/ccd.28753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/17/2020] [Indexed: 11/18/2022]
Abstract
Objectives The aim was to assess long‐term outcome after deferring intervention of coronary lesions with a fractional flow reserve (FFR) value of >0.80 in a real‐world patient population and then to identify factors associated with deferred target lesion failure (DTLF). Background Deferring coronary interventions of intermediate lesions based on FFR measurement is safe, irrespective of the extent of coronary artery disease. However, FFR values near the cut‐off of >0.80 may have less favorable outcome. Methods A retrospective analysis was performed in patients with deferred coronary intervention based on FFR value >0.80. The primary endpoint was DTLF, a composite of acute coronary syndrome (ACS) and any coronary revascularization, related to the initially deferred stenosis. Results A total of 600 patients, mean age of 66 ± 10 years, and 751 coronary lesions with negative FFR values (mean 0.88 ± 0.04) were included. The mean follow‐up was 27 ± 15 months. DTLF occurred in 44 patients (7.3%), revascularization in 42 (7%), and ACS without revascularization in 2 patients (0.3%). Patients with DTLF more often had diabetes mellitus, previous coronary artery bypass grafting, multivessel disease (MVD), and lower FFR at inclusion. Multivariable regression analysis showed that lower deferred FFR values [FFR 0.81–0.85: hazard ratio (HR) 2.79 (95% CI [confidence interval]; 1.46–5.32), p .002], MVD [HR 1.98 (95% CI; 1.05–3.75), p .036], distal lesions [HR 2.43 (95% CI; 1.29–4.57), p .006], and lesions located in a saphenous vein graft (SVG) [HR 6.35 (95% CI; 1.81–22.28), p .004] were independent predictors for DTLF. Conclusions The long‐term rate of DTLF of initially deferred coronary lesions was 7.3%. Independent predictors for DTLF are lower deferred FFR value, the presence of MVD, distal lesions, and lesions in SVG.
Collapse
Affiliation(s)
- Jerremy Weerts
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Tobias Pustjens
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Elsa Amin
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mustafa Ilhan
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Leo F Veenstra
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Ralph A L J Theunissen
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jindrich Vainer
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mera Stein
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Lex A W Ruiters
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Ben C G Gho
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Arnoud W J Van't Hof
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Saman Rasoul
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| |
Collapse
|
19
|
Escaned J, Ryan N, Mejía-Rentería H, Cook CM, Dehbi HM, Alegria-Barrero E, Alghamdi A, Al-Lamee R, Altman J, Ambrosia A, Baptista SB, Bertilsson M, Bhindi R, Birgander M, Bojara W, Brugaletta S, Buller C, Calais F, Silva PC, Carlsson J, Christiansen EH, Danielewicz M, Di Mario C, Doh JH, Erglis A, Erlinge D, Gerber RT, Going O, Gudmundsdottir I, Härle T, Hauer D, Hellig F, Indolfi C, Jakobsen L, Janssens L, Jensen J, Jeremias A, Kåregren A, Karlsson AC, Kharbanda RK, Khashaba A, Kikuta Y, Krackhardt F, Koo BK, Koul S, Laine M, Lehman SJ, Lindroos P, Malik IS, Maeng M, Matsuo H, Meuwissen M, Nam CW, Niccoli G, Nijjer SS, Olsson H, Olsson SE, Omerovic E, Panayi G, Petraco R, Piek JJ, Ribichini F, Samady H, Samuels B, Sandhall L, Sapontis J, Sen S, Seto AH, Sezer M, Sharp ASP, Shin ES, Singh J, Takashima H, Talwar S, Tanaka N, Tang K, Van Belle E, van Royen N, Varenhorst C, Vinhas H, Vrints CJ, Walters D, Yokoi H, Fröbert O, Patel MR, Serruys P, Davies JE, Götberg M. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes. JACC Cardiovasc Interv 2019; 11:1437-1449. [PMID: 30093050 DOI: 10.1016/j.jcin.2018.05.029] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.
Collapse
Affiliation(s)
- Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Nicola Ryan
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Hernán Mejía-Rentería
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | | | - Hakim-Moulay Dehbi
- CRUK & UCL Cancer Trials Centre, University College London, London, United Kingdom
| | | | - Ali Alghamdi
- King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi Arabia
| | - Rasha Al-Lamee
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - John Altman
- Colorado Heart and Vascular, Lakewood, Colorado
| | | | | | - Maria Bertilsson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Mats Birgander
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Waldemar Bojara
- Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz, Germany
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Fredrik Calais
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | | | - Jörg Carlsson
- Kalmar County Hospital, and Linnaeus University, Faculty of Health and Life Sciences, Kalmar, Sweden
| | | | | | - Carlo Di Mario
- Royal Brompton Hospital, Imperial College London, United Kingdom, and University of Florence, Florence, Italy
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Daehwa-Dong, South Korea
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Olaf Going
- Sana Klinikum Lichtenberg, Lichtenberg, Germany
| | | | - Tobias Härle
- Klinikum Oldenburg, European Medical School, Carl von Ossietzky University, Oldenburg, Germany
| | - Dario Hauer
- Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | | | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens Jensen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Cardiology, Capio S:t Görans Sjukhus, Stockholm, and Department of Medicine, Sundsvall Hospital, Sundsvall, Sweden
| | - Allen Jeremias
- Stony Brook University Medical Center, Stony Brook, New York
| | - Amra Kåregren
- Department of Internal Medicine, Västmanland Hospital Västerås, Västerås, Sweden
| | | | - Rajesh K Kharbanda
- John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, United Kingdom
| | | | | | | | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, South Korea
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mika Laine
- Helsinki University Hospital, Helsinki, Finland
| | | | - Pontus Lindroos
- Department of Cardiology, St. Göran Hospital, Stockholm, Sweden
| | - Iqbal S Malik
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, South Korea
| | | | | | - Hans Olsson
- Department of Cardiology, Karlstad Hospital, Karlstad, Sweden
| | - Sven-Erik Olsson
- Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Gothenburg, Sweden
| | - Georgios Panayi
- Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ricardo Petraco
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Jan J Piek
- AMC Heart Center, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - Bruce Samuels
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - Lennart Sandhall
- Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden
| | | | - Sayan Sen
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Arnold H Seto
- Veterans Affairs Long Beach Healthcare System, Long Beach, California
| | - Murat Sezer
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Andrew S P Sharp
- Royal Devon and Exeter Hospital and University of Exeter, Exeter, United Kingdom
| | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jasvindar Singh
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Suneel Talwar
- Royal Bournemouth General Hospital, Bournemouth, United Kingdom
| | | | - Kare Tang
- Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, United Kingdom
| | - Eric Van Belle
- Institut Coeur Poumon, Lille University Hospital, and INSERM Unité 1011, Lille, France
| | | | | | | | | | | | | | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | | | - Patrick Serruys
- Department of Cardiology, Imperial College London, London, United Kingdom
| | - Justin E Davies
- Hammersmith Hospital, Imperial College London, London, United Kingdom.
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
20
|
Kim HK, Kim HB, Lee JM, Kim SS, Bae IH, Park DS, Park JK, Shim JW, Na JY, Lee MY, Kim JS, Sim DS, Hong YJ, Nam CW, Doh JH, Park J, Koo BK, Kim SU, Lim KS, Jeong MH. Influence of Local Myocardial Infarction on Endothelial Function, Neointimal Progression, and Inflammation in Target and Non-Target Vascular Territories in a Porcine Model of Acute Myocardial Infarction. J Korean Med Sci 2019; 34:e145. [PMID: 31099195 PMCID: PMC6522891 DOI: 10.3346/jkms.2019.34.e145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/02/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) have worse clinical outcomes than those with stable coronary artery disease despite revascularization. Non-culprit lesions of AMI also involve more adverse cardiovascular events. This study aimed to investigate the influence of AMI on endothelial function, neointimal progression, and inflammation in target and non-target vessels. METHODS In castrated male pigs, AMI was induced by balloon occlusion and reperfusion into the left anterior descending artery (LAD). Everolimus-eluting stents (EES) were implanted in the LAD and left circumflex (LCX) artery 2 days after AMI induction. In the control group, EES were implanted in the LAD and LCX in a similar fashion without AMI induction. Endothelial function was assessed using acetylcholine infusion before enrollment, after the AMI or sham operation, and at 1 month follow-up. A histological examination was conducted 1 month after stenting. RESULTS A total of 10 pigs implanted with 20 EES in the LAD and LCX were included. Significant paradoxical vasoconstriction was assessed after acetylcholine challenge in the AMI group compared with the control group. In the histologic analysis, the AMI group showed a larger neointimal area and larger area of stenosis than the control group after EES implantation. Peri-strut inflammation and fibrin formation were significant in the AMI group without differences in injury score. The non-target vessel of the AMI also showed similar findings to the target vessel compared with the control group. CONCLUSION In the pig model, AMI events induced endothelial dysfunction, inflammation, and neointimal progression in the target and non-target vessels.
Collapse
Affiliation(s)
- Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Han Byul Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - In Ho Bae
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Research Institute, Jangseong, Korea
- Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Dae Sung Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Research Institute, Jangseong, Korea
- Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Research Institute of Medical Sciences, Chonnam National University, Gwangju, Korea
| | | | - Jae Won Shim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Research Institute, Jangseong, Korea
- Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Joo Young Na
- Biomedical Research Institute, Chonnam National University Hospital, Gwangju, Korea
| | - Min Young Lee
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea
| | - Joong Sun Kim
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Doo Sun Sim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Young Joon Hong
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Chang Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Joon Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jonghanne Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Bon Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- Institute on Aging, Seoul National University, Seoul, Korea
| | - Sun Uk Kim
- Futuristic Animal Resource and Research Center, Korea Research Institute of Bioscience and Biotechnology, Ochang, Korea
| | - Kyung Seob Lim
- Futuristic Animal Resource and Research Center, Korea Research Institute of Bioscience and Biotechnology, Ochang, Korea.
| | - Myung Ho Jeong
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Research Institute, Jangseong, Korea
- Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju, Korea.
| |
Collapse
|
21
|
Fukutomi M, Toriumi S, Ogoyama Y, Oba Y, Takahashi M, Funayama H, Kario K. Outcome of staged percutaneous coronary intervention within two weeks from admission in patients with ST-segment elevation myocardial infarction with multivessel disease. Catheter Cardiovasc Interv 2019; 93:E262-E268. [PMID: 30244539 DOI: 10.1002/ccd.27896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/03/2018] [Accepted: 08/29/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The optimum timing of revascularization strategy for stenoses in nonculprit vessels in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) remains unclear. At present, there is no evidence investigating the outcome of staged percutaneous coronary intervention (PCI) within two weeks from admission among STEMI patients with MVD. METHODS A total of 210 STEMI patients with MVD who underwent primary PCI were analyzed. We compared the all-cause mortality and major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, heart failure, unstable angina, and stroke) with median follow-up of 1200 days among the patients who underwent staged PCI within two weeks from admission (staged PCI ≤2 W) (n = 75), staged PCI after two weeks from admission (staged PCI >2 W) (n = 37) and culprit-only PCI (n = 98) in patients with STEMI and MVD. RESULTS The staged PCI ≤2 W showed lower all-cause mortality than culprit-only PCI (4.0 vs 29.6%, log-rank P = 0.001), and lower incidence of MACE than the staged PCI >2 W group (1.3 vs 18.9%, log-rank P = 0.001) and culprit-only PCI group (1.3 vs 22.5%, log-rank P = 0.001). In the multivariable Cox regression analysis, the staged PCI ≤2 W was a predictor of lower all-cause mortality (hazard ratio [HR], 0.176; 95% confidence interval [CI], 0.049-0.630; P = 0.008) and lower incidence of MACE (HR, 0.068; 95% CI, 0.009-0.533; P = 0.011), but staged PCI >2 W was not. CONCLUSION In conclusion, staged PCI within two weeks after admission showed more favorable outcomes compared with staged PCI after two weeks from admission or culprit-only PCI in STEMI patients with MVD.
Collapse
Affiliation(s)
- Motoki Fukutomi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Shinichi Toriumi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yukako Ogoyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yusuke Oba
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Masao Takahashi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroshi Funayama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| |
Collapse
|
22
|
Wang LJ, Han S, Zhang XH, Jin YZ. Fractional flow reserve-guided complete revascularization versus culprit-only revascularization in acute ST-segment elevation myocardial infarction and multi-vessel disease patients: a meta-analysis and systematic review. BMC Cardiovasc Disord 2019; 19:49. [PMID: 30823897 PMCID: PMC6397458 DOI: 10.1186/s12872-019-1022-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/15/2019] [Indexed: 11/17/2022] Open
Abstract
Background Approximately 30–50% patients with acute ST-segment elevation myocardial infarction (STMEI) were found to have non-infarct-related coronary artery (IRA) disease, which was significantly associated with worse prognosis. However, challenges still remain for these patients: which non-infarct-related lesion should be treated and when should the procedure be performed? The present study aims to investigate Fractional flow reserve (FFR)-guided complete revascularization (CR) in comparison to culprit-only revascularization (COR) in patients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). Methods Three appropriate randomized controlled trials (RCTs) were selected from the PubMed/Medline, EMBASE, and the Cochrane library /CENTRAL databases. 1631 patients (688 patients underwent FFR-guided CR and 943 patients underwent COR) following-up 12–44 months was evaluated. Results FFR-guided CR significantly reduced major adverse cardiac event (MACE) (OR 0.47, 95% CI: 0.35–0.62, P < 0.00001) and ischemia-driven repeat revascularization (OR 0.36, 0.26–0.51, P < 0.00001), as compared to COR. However, there is no difference in all-cause mortality (OR 1.24, 0.65–2.35, P = 0.51). Conclusions In patients with STEMI and MVD, FFR-guided CR is better than COR in terms of MACE and ischemia-driven repeat revascularization, while there are almost similar in all-cause mortality. Trial registration All analyses were based on previous published studies, thus no ethical approval and patient consent are required COMPARE-ACUTE trial number NCT01399736; DANAMI-3–PRIMULTI trial number NCT01960933. Electronic supplementary material The online version of this article (10.1186/s12872-019-1022-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Li-Jie Wang
- Department of Cardiology, the fourth Affiliated Hospital of China Medical University, Shenyang, 110032, Liaoning, China
| | - Shuo Han
- Department of Cardiology, the fourth Affiliated Hospital of China Medical University, Shenyang, 110032, Liaoning, China
| | - Xiao-Hong Zhang
- Department of Cardiology, the fourth Affiliated Hospital of China Medical University, Shenyang, 110032, Liaoning, China
| | - Yuan-Zhe Jin
- Department of Cardiology, the fourth Affiliated Hospital of China Medical University, Shenyang, 110032, Liaoning, China.
| |
Collapse
|
23
|
Liou KP, Ooi SYM, Hoole SP, West NEJ. Fractional flow reserve in acute coronary syndrome: a meta-analysis and systematic review. Open Heart 2019; 6:e000934. [PMID: 30774965 PMCID: PMC6350698 DOI: 10.1136/openhrt-2018-000934] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/05/2018] [Accepted: 11/12/2018] [Indexed: 01/02/2023] Open
Abstract
Background The utility of fractional flow reserve (FFR) to guide revascularisation in the management of acute coronary syndrome (ACS) remains unclear. Objective This study aims to compare the clinical outcomes of patients following FFR-guided revascularisation for either ACS or stable angina (SA) and in particular focuses on the outcome of those with deferred revascularisation after FFR. Methods A meta-analysis of existing literature was performed. Outcomes including the rate of major adverse cardiovascular events (MACE), recurrent myocardial infarction (MI), mortality and unplanned revascularisation were analysed. Results A review of 937 records yielded 9 studies comparing 5457 patients, which were included in the analyses. Patients with ACS had a higher rate of recurrent MI (OR 1.81, p=0.02) and a strong trend towards more MACE and all-cause mortality compared with patients with SA when treated by an FFR-guided revascularisation strategy. Deferral of invasive therapy on the basis of FFR led to a higher rate of MACE (17.6% vs 7.3 %; p=0.004), recurrent MI (5.3% vs 1.5%, p=0.001) and target vessel revascularisation (16.4% vs 5.6 %; p=0.02) in patients with ACS, and a strong trend towards a higher cardiovascular mortality at follow-up when compared with patients with SA. Conclusion The event rate in patients with ACS is much higher than SA despite following an FFR-guided revascularisation strategy. Deferring revascularisation does not appear to be as safe for ACS as it is for SA using contemporary FFR cut-offs validated in SA. Refinement of the therapeutic strategy for patients with ACS with multivessel disease is needed to redress the balance.
Collapse
Affiliation(s)
- Kevin P Liou
- Department of Interventional Cardiology, Royal Papworth Hospital, Cambridge, UK.,Eastern Heart Clinic, Prince of Wales Hospital, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Sze-Yuan M Ooi
- Eastern Heart Clinic, Prince of Wales Hospital, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Stephen P Hoole
- Department of Interventional Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Nick E J West
- Department of Interventional Cardiology, Royal Papworth Hospital, Cambridge, UK
| |
Collapse
|
24
|
Thuesen AL, Riber LP, Veien KT, Christiansen EH, Jensen SE, Modrau I, Andreasen JJ, Junker A, Mortensen PE, Jensen LO. Fractional Flow Reserve Versus Angiographically-Guided Coronary Artery Bypass Grafting. J Am Coll Cardiol 2018; 72:2732-2743. [DOI: 10.1016/j.jacc.2018.09.043] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 01/17/2023]
|
25
|
Martins JL, Afreixo V, Santos J, Gonçalves L. Fractional Flow Reserve-Guided Strategy in Acute Coronary Syndrome. A Systematic Review and Meta-Analysis. Arq Bras Cardiol 2018; 111:542-550. [PMID: 30281692 PMCID: PMC6199520 DOI: 10.5935/abc.20180170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022] Open
Abstract
Background There are limited data on the prognosis of deferral of lesion treatment in
patients with acute coronary syndrome (ACS) based on fractional flow reserve
(FFR). Objectives To provide a systematic review of the current evidence on the prognosis of
deferred lesions in ACS patients compared with deferred lesions in non-ACS
patients, on the basis of FFR. Methods We searched Medline, EMBASE, and the Cochrane Library for studies published
between January 2000 and September 2017 that compared prognosis of deferred
revascularization of lesions on the basis of FFR in ACS patients compared
with non-ACS patients. We conducted a pooled relative risk meta-analysis of
four primary outcomes: mortality, cardiovascular (CV) mortality, myocardial
infarction (MI) and target-vessel revascularization (TVR). Results We identified 7 studies that included a total of 5,107 patients. A pooled
meta-analysis showed no significant difference in mortality (relative risk
[RR] = 1.44; 95% CI, 0.9-2.4), CV mortality (RR = 1.29; 95% CI = 0.4-4.3)
and TVR (RR = 1.46; 95% CI = 0.9-2.3) after deferral of revascularization
based on FFR between ACS and non-ACS patients. Such deferral was associated
with significant additional risk of MI (RR = 1.83; 95% CI = 1.4-2.4) in ACS
patients. Conclusion The prognostic value of FFR in ACS setting is not as good as in stable
patients. The results demonstrate an increased risk of MI but not of
mortality, CV mortality, and TVR in ACS patients.
Collapse
Affiliation(s)
- José Luís Martins
- Department of Cardiology, Baixo Vouga Hospital Center, Aveiro - Portugal
| | - Vera Afreixo
- CIDMA/IBIMED/Department of Mathematics, University of Aveiro, Aveiro - Portugal
| | - José Santos
- Department of Cardiology, Baixo Vouga Hospital Center, Aveiro - Portugal
| | - Lino Gonçalves
- Department of Cardiology, Coimbra Universitary Hospital Center, Coimbra - Portugal
| |
Collapse
|
26
|
Paganelli F, Resseguier N, Marlinge M, Laine M, Malergue F, Kipson N, Armangau P, Pezzoli N, Kerbaul F, Bonello L, Mottola G, Fenouillet E, Guieu R, Ruf J. Specific Pharmacological Profile of A 2A Adenosine Receptor Predicts Reduced Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease. J Am Heart Assoc 2018; 7:JAHA.117.008290. [PMID: 29654194 PMCID: PMC6015402 DOI: 10.1161/jaha.117.008290] [Citation(s) in RCA: 13] [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: 12/18/2022]
Abstract
Background The rapid and reliable exclusion of myocardial revascularization is a major unmet clinical need in patients with suspected coronary artery disease (CAD) and non‐contributive electrocardiography and troponin. Non‐invasive tests have high rates of false positives and negatives, and there is no biomarker to assess myocardial ischemia. The presence of spare adenosine A2A receptors (A2AR)—characterized by a high dissociation constant/half maximal effective concentration (KD/EC50) ratio—expressed on peripheral blood mononuclear cells (PBMC) has been associated with ischemia during exercise stress testing in patients with CAD. In this work, we investigated the diagnostic accuracy of spare A2AR versus fractional flow reserve (FFR) in patients with suspected CAD. Methods and Results Sixty patients with suspected CAD, but non‐contributive electrocardiography and troponin, were consecutively enrolled in this prospective study. The binding (KD), functional response (cyclic adenosine monophosphate [cAMP] production; EC50) on PBMC A2AR were compared with FFR results. Patients were divided into 3 groups: 17 (group 1) with normal coronary angiography (n=13) or stenosis <20% (n=4); 21 with CAD and non‐significant FFR (group 2); and 22 with CAD and significant FFR (group 3). Median KD/EC50 was 6‐fold higher in group 3 (4.20; interquartile range: 2.81–5.00) than group 2 (0.66; interquartile range: 0.47–1.25) and 7‐fold higher than group 1 (0.60; interquartile range: 0.30–0.66). Conclusions In patients with suspected CAD and non‐contributive electrocardiography and troponin, the absence of spare A2AR on PBMC may help to rule out myocardial ischemia. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03218007.
Collapse
Affiliation(s)
- Franck Paganelli
- Department of Cardiology, Hopital Nord, AP-HM, Aix-Marseille University, Marseille, France
| | - Noémie Resseguier
- Chronic Diseases and Quality of Life Research Unit, EA 3279 Public Health, Aix-Marseille University, Marseille, France
| | | | - Marc Laine
- Department of Cardiology, Hopital Nord, AP-HM, Aix-Marseille University, Marseille, France
| | | | | | - Pauline Armangau
- Department of Cardiology, Hopital Nord, AP-HM, Aix-Marseille University, Marseille, France
| | - Nicolas Pezzoli
- Laboratory of Biochemistry, Hopital Nord, AP-HM, Aix-Marseille University, Marseille, France
| | | | - Laurent Bonello
- Department of Cardiology, Hopital Nord, AP-HM, Aix-Marseille University, Marseille, France
| | | | | | - Régis Guieu
- UMR MD2, Aix-Marseille University, Marseille, France
| | - Jean Ruf
- UMR MD2, Aix-Marseille University, Marseille, France
| |
Collapse
|