Joo Myung Lee1, Bon-Kwon Koo2,3, Eun-Seok Shin4, Chang-Wook Nam5, Joon-Hyung Doh6, Doyeon Hwang2, Jonghanne Park2, Kyung-Jin Kim2, Jinlong Zhang2, Xinyang Hu7, JianAn Wang7, Chul Ahn8, Fei Ye9, Shaoliang Chen9, Junqing Yang10, Jiyan Chen10, Nobuhiro Tanaka11, Hiroyoshi Yokoi12, Hitoshi Matsuo13, Hiroaki Takashima14, Yasutsugu Shiono15, Takashi Akasaka15. 1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, 50, Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. 2. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Korea. 3. Institute on Aging, Seoul National University, 50, Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. 4. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. 5. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea. 6. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea. 7. Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China. 8. Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA. 9. Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. 10. Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. 11. Department of Cardiology, Tokyo Medical University, Tokyo, Japan. 12. Kokura Memorial Hospital, Kitakyuku, Japan. 13. Department of Cardiology, Gifu Heart Center, Gifu, Japan. 14. Department of Cardiology, Aichi Medical University, Nagakute, Japan. 15. Wakayama Medical University, Wakayama, Japan.
Abstract
Aims: There are limited data on the clinical implications of total physiologic atherosclerotic burden assessed by invasive physiologic studies in patients with coronary artery disease. We investigated the prognostic implications of total physiologic atherosclerotic burden assessed by total sum of fractional flow reserve (FFR) in three vessels (3V-FFR). Methods and results: A total of 1136 patients underwent FFR measurement in three vessels (3V FFR-FRIENDS study, NCT01621438). The patients were classified into high and low 3V-FFR groups according to the median value of 3V-FFR (2.72). The primary endpoint was major adverse cardiac events (MACE, a composite of cardiac death, myocardial infarction and ischaemia-driven revascularization) at 2 years. Mean angiographic percent diameter stenosis and FFR were 43.7 ± 19.3% and 0.90 ± 0.08, respectively. There was a negative correlation between 3V-FFR and estimated 2-year MACE rate (P < 0.001). The patients in low 3V-FFR group showed a higher risk of 2-year MACE than those in the high 3V-FFR group [(7.1% vs. 3.8%, hazard ratio (HR) 2.205, 95% confidence interval (CI) 1.201-4.048, P = 0.011]. The higher 2-year MACE rate was mainly driven by the higher rate of ischaemia-driven revascularization in the low 3V-FFR group (6.2% vs. 2.7%, HR 2.568, 95% CI 1.283-5.140, P = 0.008). In a multivariable adjusted model, low 3V-FFR was an independent predictor of MACE (HR 2.031, 95% CI 1.078-3.830, P = 0.029). Conclusion: Patients with high total physiologic atherosclerotic burden assessed by 3V-FFR showed higher risk of 2-year clinical events than those with low total physiologic atherosclerotic burden. The difference was mainly driven by ischaemia-driven revascularization for both functionally significant and insignificant lesions at baseline. Three-vessel FFR might be used as a prognostic indicator in patients with coronary artery disease. Clinical trial registration: 3V FFR-FRIENDS study (https://clinicaltrials.gov/ct2/show/NCT01621438, NCT01621438).
Aims: There are limited data on the clinical implications of total physiologic atherosclerotic burden assessed by invasive physiologic studies in patients with coronary artery disease. We investigated the prognostic implications of total physiologic atherosclerotic burden assessed by total sum of fractional flow reserve (FFR) in three vessels (3V-FFR). Methods and results: A total of 1136 patients underwent FFR measurement in three vessels (3V FFR-FRIENDS study, NCT01621438). The patients were classified into high and low 3V-FFR groups according to the median value of 3V-FFR (2.72). The primary endpoint was major adverse cardiac events (MACE, a composite of cardiac death, myocardial infarction and ischaemia-driven revascularization) at 2 years. Mean angiographic percent diameter stenosis and FFR were 43.7 ± 19.3% and 0.90 ± 0.08, respectively. There was a negative correlation between 3V-FFR and estimated 2-year MACE rate (P < 0.001). The patients in low 3V-FFR group showed a higher risk of 2-year MACE than those in the high 3V-FFR group [(7.1% vs. 3.8%, hazard ratio (HR) 2.205, 95% confidence interval (CI) 1.201-4.048, P = 0.011]. The higher 2-year MACE rate was mainly driven by the higher rate of ischaemia-driven revascularization in the low 3V-FFR group (6.2% vs. 2.7%, HR 2.568, 95% CI 1.283-5.140, P = 0.008). In a multivariable adjusted model, low 3V-FFR was an independent predictor of MACE (HR 2.031, 95% CI 1.078-3.830, P = 0.029). Conclusion:Patients with high total physiologic atherosclerotic burden assessed by 3V-FFR showed higher risk of 2-year clinical events than those with low total physiologic atherosclerotic burden. The difference was mainly driven by ischaemia-driven revascularization for both functionally significant and insignificant lesions at baseline. Three-vessel FFR might be used as a prognostic indicator in patients with coronary artery disease. Clinical trial registration: 3V FFR-FRIENDS study (https://clinicaltrials.gov/ct2/show/NCT01621438, NCT01621438).
Authors: Hak Seung Lee; Joo Myung Lee; Chang-Wook Nam; Eun-Seok Shin; Joon-Hyung Doh; Neng Dai; Martin K C Ng; Andy S C Yong; Damras Tresukosol; Ajit S Mullasari; Rony Mathew; Praveen Chandra; Kuang-Te Wang; Yundai Chen; Jiyan Chen; Kai-Hang Yiu; Nils P Johnson; Bon-Kwon Koo Journal: Cardiol J Date: 2019-06-21 Impact factor: 2.737
Authors: Joo Myung Lee; Ki Hong Choi; Bon-Kwon Koo; Hakim-Moulay Dehbi; Joon-Hyung Doh; Chang-Wook Nam; Eun-Seok Shin; Christopher M Cook; Rasha Al-Lamee; Ricardo Petraco; Sayan Sen; Iqbal S Malik; Sukhjinder S Nijjer; Hernán Mejía-Rentería; Eduardo Alegria-Barrero; Ali Alghamdi; John Altman; Sérgio B Baptista; Ravinay Bhindi; Waldemar Bojara; Salvatore Brugaletta; Pedro Canas Silva; Carlo Di Mario; Andrejs Erglis; Robert T Gerber; Olaf Going; Tobias Härle; Farrel Hellig; Ciro Indolfi; Luc Janssens; Allen Jeremias; Rajesh K Kharbanda; Ahmed Khashaba; Yuetsu Kikuta; Florian Krackhardt; Mika Laine; Sam J Lehman; Hitoshi Matsuo; Martijin Meuwissen; Giampaolo Niccoli; Jan J Piek; Flavo Ribichini; Habib Samady; James Sapontis; Arnold H Seto; Murat Sezer; Andrew S P Sharp; Jasvindar Singh; Hiroaki Takashima; Suneel Talwar; Nobuhiro Tanaka; Kare Tang; Eric Van Belle; Niels van Royen; Hugo Vinhas; Christiaan J Vrints; Darren Walters; Hiroyoshi Yokoi; Bruce Samuels; Chris Buller; Manesh R Patel; Patrick Serruys; Javier Escaned; Justin E Davies Journal: JAMA Cardiol Date: 2019-09-01 Impact factor: 14.676