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Sex Differences in Fractional FlowReserve- or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention

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Author(s)
Jinlong ZhangJun JiangXinyang HuYong SunChangling LiLingjun ZhuFeng GaoLiang DongYabin LiuJian ShenCheng NiKan WangZexin ChenHaibo ChenShiqiang LiSeokhun YangJeehoon KangDoyeon HwangJoo-Yong HahnChang-Wook NamJoon-Hyung DohBong-Ki LeeWeon KimJinyu HuangFan JiangHao ZhouPeng ChenLijiang TangWenbing JiangXiaomin ChenWenming HeSung Gyun AhnMyeong-Ho YoonUng KimJoo Myung LeeYou-Jeong KiEun-Seok ShinChee Hae KimSeung-Jea TahkBon-Kwon KooJian'an Wang
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
JACC Cardiovasc Interv
Issued Date
2023
Volume
16
Issue
19
Keyword
fractional flow reserveintravascular ultrasoundoutcomepercutaneous coronary interventionsex difference
Abstract
Background:
A recent randomized trial reported fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy was noninferior to the intracoronary ultrasound (IVUS)-guided PCI strategy with respect to clinical outcomes with fewer revascularizations.

Objectives:
This study sought to investigate the sex differences in treatment and clinical outcomes according to physiology- or imaging-guided PCI strategies.

Methods:
In this secondary analysis of the FLAVOUR (Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI) trial, the impact of sex on procedural characteristics, PCI rate, and outcomes according to different strategies and treatment types (PCI vs deferral of PCI) was analyzed. The primary outcome was target vessel failure (TVF) at 24 months, defined as a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization.

Results:
Of 1,619 patients, 30% were women. Compared with men, women had a smaller minimal lumen area, smaller plaque burden, and higher FFR. They had a lower PCI rate (40.8% vs 47.9%; P = 0.008), which was mainly contributed by FFR guidance. Overall, women showed a lower TVF rate (2.4% vs 4.5%). According to the treatment type, the cumulative incidence of TVF was lower in women than in men among those with the deferral of PCI (1.7% vs 5.2%). However, this trend was not observed in patients who underwent PCI. In both women and men, there were no differences in clinical outcomes between the FFR- and IVUS-guided strategies.

Conclusions:
In cases of intermediate stenosis, despite receiving fewer interventions, women had more favorable outcomes than men. The use of FFR led to a lower PCI rate but had a similar prognostic value compared with IVUS in both women and men.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1876-7605
Source
https://www.sciencedirect.com/science/article/pii/S1936879823011962
DOI
10.1016/j.jcin.2023.08.017
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45263
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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