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Prognostic Value of Resting Distal-to-Aortic Coronary Pressure in Clinical Practice

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Author(s)
Jung-Min AhnDuk-Woo ParkSeon-Ok KimDo-Yoon KangCheol-Hyun LeePil Hyung LeeSeung-Whan LeeSeong-Wook ParkSeung-Jung Park
Keimyung Author(s)
Lee, Cheol Hyun
Department
Dept. of Internal Medicine (내과학)
Journal Title
Circulation. Cardiovascular interventions
Issued Date
2020
Volume
13
Issue
5
Keyword
coronary artery diseasedeath, sudden, cardiacfollow-up studieshumansregistries
Abstract
Background:
The resting distal-to-aortic coronary pressure ratio (Pd/Pa) is a universally available, hyperemia-free physiological index of coronary stenosis. We investigated clinical outcomes according to resting Pd/Pa versus hyperemic fractional flow reserve (FFR).

Methods:
From the IRIS-FFR (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve) registry, 7014 lesions in 4707 patients with valid resting Pd/Pa and FFR were included in this study. The primary outcome was major adverse cardiac events (MACE; a composite of cardiac death, myocardial infarction, and repeat intervention). The MACE rate was compared among resting Pd/Pa ≤0.92 and FFR ≤0.80. A marginal Cox model accounted for correlated data in patients with multiple lesions.

Results:
During a median follow-up of 2.0 years, 223 MACEs occurred. Resting Pd/Pa was an independent predictor for the occurrence of MACE (adjusted hazard ratio [aHR], 1.89 [95% CI, 1.32–2.71]; P=0.001) over clinical and angiographic variables. When resting Pd/Pa and FFR were added into a multivariable model, MACE was no longer significantly associated with resting Pd/Pa (aHR, 1.35 [95% CI, 0.93–1.97]; P=0.12) but remained to be associated with FFR (aHR, 2.34 [95% CI, 1.56–3.54]; P<0.001). Compared with lesions with normal value of resting Pa/Pa and FFR, lesions with abnormal values of either resting Pd/Pa (aHR, 2.12 [95% CI, 1.17–3.84]; P=0.014) or FFR (aHR, 2.32 [95% CI, 1.52–3.55]; P<0.001) or both (aHR, 2.37 [95% CI, 1.57–3.57]; P<0.001) showed a significantly increased risk of the occurrence of MACE.

Conclusions:
Resting Pd/Pa appeared to be a less-robust prognostic index than FFR. Resting Pd/Pa could be used as a prognostic index when hyperemic agents are contraindicated or not easily available.
Keimyung Author(s)(Kor)
이철현
Publisher
School of Medicine (의과대학)
Citation
Jung-Min Ahn et al. (2020). Prognostic Value of Resting Distal-to-Aortic Coronary Pressure in Clinical Practice. Circulation. Cardiovascular interventions, 13(5), e007868. doi: 10.1161/CIRCINTERVENTIONS.118.007868
Type
Article
ISSN
1941-7632
Source
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.118.007868
DOI
10.1161/CIRCINTERVENTIONS.118.007868
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43015
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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