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Residual functional SYNTAX score by quantitative flow ratio and improvement of exercise capacity after revascularization

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Author(s)
Seung Hun LeeKi Hong ChoiJoo Myung LeeDoosup ShinDoyeon HwangHyun Kuk KimJoon‐Hyung DohChang‐Wook NamEun‐Seok ShinMi Ja JangSe Young ImTaek Kyu ParkJeong Hoon YangYoung Bin SongJoo‐Yong HahnSeung‐Hyuk ChoiBon‐Kwon KooHyeon‐Cheol Gwon
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Issued Date
2021
Volume
97
Issue
4
Keyword
exercise testischemic heart diseasepercutaneous coronary interventionquantitative flow ratioresidual SYNTAX score
Abstract
Objectives:
This study aimed to evaluate the association between improvement in exercise capacity and functional completeness of revascularization, determined by residual functional SYNTAX score (rFSS), which is the sum of residual SYNTAX score of the vessels with post‐ percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) ≤0.80.

Background:
In patients with stable ischemic heart disease (SIHD), the efficacy of PCI in improving exercise capacity has been under debate and the differential effect of PCI for exercise capacity, according to functional completeness of revascularization, has not been evaluated.

Methods:
Among patients enrolled in the QFR multicenter registry, 110 patients who underwent routine exercise treadmill tests before and after PCI were analyzed. Patients were classified into functional complete revascularization (CR) group (rFSS = 0) and functional incomplete revascularization (IR) group (rFSS ≥ 1). Increase of exercise time after PCI was compared between the two groups. Improvement of exercise capacity was defined as ≥10% increase of exercise time after PCI.

Results:
Functional CR was achieved in 79 patients (71.8%), otherwise classified as functional IR in 31 patients (28.2%) without differences in baseline characteristics including medication profiles. Increase of exercise time was significantly associated with increase of 3‐vessel QFR (sum of QFRs in all three vessels; r = .198, p = .038) and rFSS (r = −.312, p < .001), but not with decrease of SYNTAX score (r = .097, p = .313). The rFSS showed significantly higher c‐index to predict the improvement of exercise capacity after PCI than increase of 3‐vessel QFR or decrease of SYNTAX score (0.722 vs. 0.627 vs. 0.492, respectively, p < 0.001). Patients with functional CR, defined by rFSS, showed significantly higher absolute and relative increase in exercise time than those with functional IR (97.7 s vs. 12.5 s, p < .001; 25.4% vs. 3.6%, p = .001). Functional CR was an independent predictor for improvement of exercise capacity after PCI (adjusted OR 4.656, 95% CI 1.678–12.920, p = .002).

Conclusions:
Integrated anatomic and functional scoring system (rFSS) was significantly associated with improvement of exercise capacity after PCI. SIHD patients with functional CR, defined by rFSS, showed significantly higher exercise capacity after PCI than those with functional IR.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Citation
Seung Hun Lee et al. (2021). Residual functional SYNTAX score by quantitative flow ratio and improvement of exercise capacity after revascularization. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 97(4), E454–E466. doi: 10.1002/ccd.29118
Type
Article
ISSN
1522-726X
Source
https://onlinelibrary.wiley.com/doi/full/10.1002/ccd.29118
DOI
10.1002/ccd.29118
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43010
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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