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Association between patient age, microcirculation, and coronary stenosis assessment with fractional flow reserve and instantaneous wave-free ratio

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Author(s)
Hernan Mejia-RenteriaDaniel FariaJoo Myung LeeSeung Hun LeeJi-Hyun JungJoon-Hyung DohChang-Wook NamEun-Seok ShinMasahiro HoshinoTomoyo SugiyamaYoshihisa KanajiNieves GonzaloTsunekazu KakutaBon-Kwon KooJavier Escaned
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
Catheter Cardiovasc Interv
Issued Date
2022
Volume
99
Issue
4
Keyword
agingclinical outcomesFFRiFRmicrocirculation
Abstract
Objectives:
To investigate the effect of aging on coronary stenosis functional assessment with fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR).

Background:
Limited data exist regarding the impact of patient age on these coronary pressure indices.

Methods:
We analyzed 514 patients with coronary stenosis interrogated with intravascular physiology. The influence of patient age on FFR, iFR, and microcirculation-related indices was investigated. Vessel-oriented composite outcome (VOCO) was assessed in the FFR-based deferred population according to iFR, coronary flow reserve (CFR), and age.

Results:
FFR increased (r = 0.128, p = 0.004), iFR remained unchanged (r = −0.001, p = 0.980), and CFR decreased (r = −0.095, p = 0.001) with patient age. Relationship between FFR and CFR differed across age groups (r = 0.263 in <60 years old vs. r = 0.124 in ≥60 years old, p = 0.0056), whereas iFR correlated to CFR similarly regardless age (r = 0.283 in <60 years old vs. r = 0.219 in ≥60 years old, p = 0.3781). No differences were found on angiographic stenosis severity (%DS 47.4 in <60 years old and 49.8 in ≥60 years old, p = 0.317). At 5 years, FFR-based revascularisation deferral in patients ≥60 years old was associated with more VOCO when either iFR (25%) or CFR (16.9%) were abnormal, compared to patients with normal iFR (6.3%) or normal CFR (4.6%) (log-rank p < 0.001). This difference in clinical outcomes was not observed in younger patients.

Conclusions:
FFR values increased progressively with patient age, potentially associated with age-related changes in the coronary microcirculation. Conversely, iFR values remained unchanged across the patient age spectrum. In ≥60 years old patients with revascularisation deferral based on FFR, both abnormal iFR and CFR values were associated with worse long-term patient outcomes.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Citation
Hernan Mejia-Renteria et al. (2022). Association between patient age, microcirculation, and coronary stenosis assessment with fractional flow reserve and instantaneous wave-free ratio. Catheter Cardiovasc Interv, 99(4), 1104–1114. doi: 10.1002/ccd.30092
Type
Article
ISSN
1522-726X
Source
https://onlinelibrary.wiley.com/doi/10.1002/ccd.30092
DOI
10.1002/ccd.30092
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44176
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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