계명대학교 의학도서관 Repository

Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment

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Author(s)
Sayan SenYousif AhmadHakim-Moulay DehbiJames P. HowardJuan F. IglesiasRasha Al-LameeRicardo PetracoSukhjinder NijjerRavinay BhindiSam LehmanDarren WaltersJames SapontisLuc JanssensChristiaan J. VrintsAhmed KhashabaMika LaineEric Van BelleFlorian KrackhardtWaldemar BojaraOlaf GoingTobias HärleCiro IndolfiGiampaolo NiccoliFlavio RibichiniNobuhiro TanakaHiroyoshi YokoiHiroaki TakashimaYuetsu KikutaAndrejs ErglisHugo VinhasPedro Canas SilvaSérgio B. BaptistaAli AlghamdiFarrel HelligBon-Kwon KooChang-Wook NamEun-Seok ShinJoon-Hyung DohSalvatore BrugalettaEduardo Alegria-BarreroMartijin MeuwissenJan J. PiekNiels van RoyenMurat SezerAndrew S.P. SharpSuneel TalwarKare TangHabib SamadyJohn AltmanArnold H. SetoJasvindar SinghAllen JeremiasHitoshi MatsuoRajesh K. KharbandaManesh R. PatelPatrick SerruysJavier EscanedJustin E. DaviesCarlo Di MarioRobert T. GerberIqbal S. Malik
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
Journal of the American College of Cardiology
Issued Date
2019
Volume
73
Issue
4
Keyword
coronary stenosisfractional flow reserveinstantaneous wave-free ratio
Abstract
BACKGROUND
Physicians are not always comfortable deferring treatment of a stenosis in the left anterior descending (LAD) artery because of the perception that there is a high risk of major adverse cardiac events (MACE). The authors describe, using the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) trial, MACE rates when LAD lesions are deferred, guided by physiological assessment using fractional flow reserve (FFR) or the instantaneous wave-free ratio (iFR).

OBJECTIVES
The purpose of this study was to establish the safety of deferring treatment in the LAD using FFR or iFR within the DEFINE-FLAIR trial.

METHODS
MACE rates at 1 year were compared between groups (iFR and FFR) in patients whose physiological assessment led to LAD lesions being deferred. MACE was defined as a composite of cardiovascular death, myocardial infarction (MI), and unplanned revascularization at 1 year. Patients, and staff performing follow-up, were blinded to whether the decision was made with FFR or iFR. Outcomes were adjusted for age and sex.

RESULTS
A total of 872 patients had lesions deferred in the LAD (421 guided by FFR, 451 guided by iFR). The event rate with iFR was significantly lower than with FFR (2.44% vs. 5.26%; adjusted HR: 0.46; 95% confidence interval [CI]: 0.22 to 0.95; p ¼ 0.04). This was driven by significantly lower unplanned revascularization with iFR and numerically lower MI (unplanned revascularization: 2.22% iFR vs. 4.99% FFR; adjusted HR: 0.44; 95% CI: 0.21 to 0.93; p ¼ 0.03; MI: 0.44% iFR vs. 2.14% FFR; adjusted HR: 0.23; 95% CI: 0.05 to 1.07; p ¼ 0.06).

CONCLUSIONS
iFR-guided deferral appears to be safe for patients with LAD lesions. Patients in whom iFR-guided deferral was performed had statistically significantly lower event rates than those with FFR-guided deferral.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Citation
Sayan Sen et al. (2019). Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment. Journal of the American College of Cardiology, 73(4), 444–453. doi: 10.1016/j.jacc.2018.10.070
Type
Article
ISSN
1558-3597
Source
https://www.sciencedirect.com/science/article/pii/S0735109718393045?via%3Dihub
DOI
10.1016/j.jacc.2018.10.070
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41920
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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