Influence of Anatomical and Clinical Characteristics on Long-Term Prognosis of FFR-Guided Deferred Coronary Lesions
- Author(s)
- Yun-Kyeong Cho; Jongmin Hwang; Cheol Hyun Lee; In-Cheol Kim; Hyoung-Seob Park; Hyuck-Jun Yoon; Hyungseop Kim; Seong-Wook Han; Seung-Ho Hur; Kwon-Bae Kim; Jin Young Kim; Joon-Hyung Doh; Eun-Seok Shin; Bon-Kwon Koo; Chang Wook Nam
- Keimyung Author(s)
- Cho, Yun Kyeong; Hwang, Jong Min; Lee, Cheol Hyun; Kim, In Cheol; Park, Hyoung Seob; Yoon, Hyuck Jun; Kim, Hyung Seop; Han, Seong Wook; Hur, Seung Ho; Kim, Kwon Bae; Kim, Jin Young; Nam, Chang Wook
- Department
- Dept. of Internal Medicine (내과학)
Dept. of Radiology (영상의학)
- Journal Title
- JACC: Cardiovascular interventions
- Issued Date
- 2020
- Volume
- 13
- Issue
- 16
- Keyword
- fractional flow reserve; intravascular ultrasound; prognosis
- Abstract
- Objectives:
The aim of this study was to evaluate the clinical and anatomical features to predict the long-term outcomes in patients with fractional flow reserve (FFR)–guided deferred lesions, verified by intravascular ultrasound (IVUS).
Background:
Deferral of nonsignificant lesion by FFR is associated with a low risk of clinical events. However, the impact of combined information on clinical and anatomical factors is not well known.
Methods:
The study included 459 patients with 552 intermediate lesions who had deferred revascularization on the basis of a nonischemic FFR (>0.80). Grayscale IVUS was examined simultaneously. The primary endpoint was patient-oriented composite outcome (POCO) (a composite of all-cause death, myocardial infarction, and any revascularization) during 5-year follow-up.
Results:
The rate of 5-year POCO was 9.8%. Diabetes mellitus (hazard ratio: 3.50; 95% confidence interval [CI]: 1.86 to 6.57; p < 0.001), left ventricular ejection fraction ≤40% (hazard ratio: 4.80; 95% CI: 1.57 to 14.63; p = 0.006), and positive remodeling (hazard ratio: 2.04; 95% CI: 1.03 to 4.03; p = 0.041) were independent predictors for POCO. When the lesions were classified according to the presence of the adverse clinical characteristics (diabetes, left ventricular ejection fraction ≤40%) or adverse plaque characteristics (positive remodeling, plaque burden ≥70%), the risk of POCO was incrementally increased (4.3%, 13.6%, and 21.3%, respectively; p < 0.001).
Conclusions:
In patients with FFR-guided deferred lesions, 5-year clinical outcomes were excellent. Lesion-related anatomical factors from intravascular imaging as well as patient-related clinical factors could provide incremental information about future clinical risks.
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