Nobuhiro Tanaka1, Masato Nakamura2, Takashi Akasaka3, Kazushige Kadota4, Shirou Uemura5, Tetsuya Amano6, Nobuo Shiode7, Yoshihiro Morino8, Kenshi Fujii9, Yutaka Hikichi10. 1. Department of Cardiology, Tokyo Medical University Hachioji Medical Center. 2. Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine. 3. Department of Cardiovascular Medicine, Wakayama Medical University. 4. Department of Cardiology, Kurashiki Central Hospital. 5. Cardiovascular Medicine, Kawasaki Medical University. 6. Department of Cardiology, Aichi Medical University. 7. Division of Cardiology, Tsuchiya General Hospital. 8. Division of Cardiology, Iwate Medical University Hospital. 9. Cardiovascular Center, Sakurabashi Watanabe Hospital. 10. Department of Cardiovascular Medicine, Saga University.
Abstract
BACKGROUND: Clinical use of fractional flow reserve (FFR) has been rapidly increasing, but outcomes after FFR-based coronary intervention in Japanese daily clinical practice have not been well investigated.Methods and Results: The prospective multicenter cardiovascular intervention therapeutics registry (CVIT)-DEFER enrolled consecutive patients for whom FFR measurement was clinically indicated. This study comprised 3,857 vessels in 3,272 patients. Lesions were categorized into 4 groups according to FFR result and revascularization strategy: group 1: FFR >0.8, and deferral of PCI (n=1992); group 2: FFR >0.8, then PCI (n=230); group 3: FFR ≤0.8, and deferral of PCI (n=506); and group 4: FFR ≤0.8, then PCI (n=1,129). The event rate for deferred lesions was significantly low compared with that for PCI lesions (3.5% vs. 6.6%; P<0.05). Vessel-related events occurred in 62 (3.1%), 11 (4.8%), 25 (4.9%), and 79 (7.0%) patients in groups 1, 2, 3, and 4, respectively. PCI for lesions in which FFR was >0.8 (group 2) showed no improvement in the event rate compared with a defer-strategy. On the other hand, deferred lesions with lower FFR values had a higher risk of vessel-related events. CONCLUSIONS: A FFR-based revascularization strategy in daily clinical practice was safe with regard to vessel-related events.
BACKGROUND: Clinical use of fractional flow reserve (FFR) has been rapidly increasing, but outcomes after FFR-based coronary intervention in Japanese daily clinical practice have not been well investigated.Methods and Results: The prospective multicenter cardiovascular intervention therapeutics registry (CVIT)-DEFER enrolled consecutive patients for whom FFR measurement was clinically indicated. This study comprised 3,857 vessels in 3,272 patients. Lesions were categorized into 4 groups according to FFR result and revascularization strategy: group 1: FFR >0.8, and deferral of PCI (n=1992); group 2: FFR >0.8, then PCI (n=230); group 3: FFR ≤0.8, and deferral of PCI (n=506); and group 4: FFR ≤0.8, then PCI (n=1,129). The event rate for deferred lesions was significantly low compared with that for PCI lesions (3.5% vs. 6.6%; P<0.05). Vessel-related events occurred in 62 (3.1%), 11 (4.8%), 25 (4.9%), and 79 (7.0%) patients in groups 1, 2, 3, and 4, respectively. PCI for lesions in which FFR was >0.8 (group 2) showed no improvement in the event rate compared with a defer-strategy. On the other hand, deferred lesions with lower FFR values had a higher risk of vessel-related events. CONCLUSIONS: A FFR-based revascularization strategy in daily clinical practice was safe with regard to vessel-related events.
Entities:
Keywords:
Fractional flow reserve; Japanese Association of Cardiovascular Intervention Therapeutics (CVIT); Percutaneous coronary intervention