Giovanni Ciccarelli1, Emanuele Barbato1,2, Gabor G Toth3, Brigitta Gahl4, Panagiotis Xaplanteris1, Stephane Fournier1, Anastasios Milkas1, Jozef Bartunek1, Marc Vanderheyden1, Nico Pijls5, Pim Tonino6, William F Fearon7, Peter Jüni8, Bernard De Bruyne9. 1. Cardiovascular Center, OLV Hospital, Aalst, Belgium (G.C., E.B., P.X., S.F., A.M., J.B., M.V., B.D.B.). 2. Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.). 3. University Heart Centre Graz, Austria (G.G.T.). 4. Department of Clinical Research, CTU Bern, University of Bern, Switzerland (B.G.). 5. Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (N.P., P.T.). 6. Stanford University Medical Center, CA (W.F.F.). 7. Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada (P.J.). 8. Department of Medicine, University of Toronto, Ontario, Canada (P.J.). 9. Cardiovascular Center, OLV Hospital, Aalst, Belgium (G.C., E.B., P.X., S.F., A.M., J.B., M.V., B.D.B.) bernard.de.bruyne@olvz-aalst.be.
Abstract
BACKGROUND: Among patients with documented stable coronary artery disease and in whom no revascularization was performed, we compared the respective values of angiographic diameter stenosis (DS) and fractional flow reserve (FFR) in predicting natural history. METHODS: The present analysis included the 607 patients from the FAME 2 trial (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation 2) in whom no revascularization was performed. FFR varied from 0.20 to 1.00 (average 0.74±0.16), and DS (by quantitative coronary analysis) varied from 8% to 98% (average 53±15). The primary end point, defined as vessel-oriented clinical end point (VOCE) at 2 years, was a composite of prospectively adjudicated cardiac death, vessel-related myocardial infarction, vessel-related urgent, and not urgent revascularization. The stenoses were divided into 4 groups according to FFR and %DS values: positive concordance (FFR≤0.80; DS≥50%), negative concordance (FFR>0.80; DS<50%), positive mismatch (FFR≤0.80; DS<50%), and negative mismatch (FFR>0.80; DS≥50%). RESULTS: The rate of VOCE was highest in the positive concordance group (log rank: X2=80.96; P=0.001) and lowest in the negative concordance group. The rate of VOCE was higher in the positive mismatch group than in the negative mismatch group (hazard ratio, 0.38; 95% confidence interval, 0.21-0.67; P=0.001). There was no significant difference in VOCE between the positive concordance and positive mismatch groups (FFR≤0.80; hazard ratio, 0.77; 95% confidence interval, 0.57-1.09; P=0.149) and no significant difference in rate of VOCE between the negative mismatch and negative concordance groups (FFR>0.80; hazard ratio, 1.89; 95% confidence interval, 0.96-3.74; P=0.067). CONCLUSIONS: In patients with stable coronary disease, physiology (FFR) is a more important determinant of the natural history of coronary stenoses than anatomy (DS). CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT01132495.
BACKGROUND: Among patients with documented stable coronary artery disease and in whom no revascularization was performed, we compared the respective values of angiographic diameter stenosis (DS) and fractional flow reserve (FFR) in predicting natural history. METHODS: The present analysis included the 607 patients from the FAME 2 trial (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation 2) in whom no revascularization was performed. FFR varied from 0.20 to 1.00 (average 0.74±0.16), and DS (by quantitative coronary analysis) varied from 8% to 98% (average 53±15). The primary end point, defined as vessel-oriented clinical end point (VOCE) at 2 years, was a composite of prospectively adjudicated cardiac death, vessel-related myocardial infarction, vessel-related urgent, and not urgent revascularization. The stenoses were divided into 4 groups according to FFR and %DS values: positive concordance (FFR≤0.80; DS≥50%), negative concordance (FFR>0.80; DS<50%), positive mismatch (FFR≤0.80; DS<50%), and negative mismatch (FFR>0.80; DS≥50%). RESULTS: The rate of VOCE was highest in the positive concordance group (log rank: X2=80.96; P=0.001) and lowest in the negative concordance group. The rate of VOCE was higher in the positive mismatch group than in the negative mismatch group (hazard ratio, 0.38; 95% confidence interval, 0.21-0.67; P=0.001). There was no significant difference in VOCE between the positive concordance and positive mismatch groups (FFR≤0.80; hazard ratio, 0.77; 95% confidence interval, 0.57-1.09; P=0.149) and no significant difference in rate of VOCE between the negative mismatch and negative concordance groups (FFR>0.80; hazard ratio, 1.89; 95% confidence interval, 0.96-3.74; P=0.067). CONCLUSIONS: In patients with stable coronary disease, physiology (FFR) is a more important determinant of the natural history of coronary stenoses than anatomy (DS). CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT01132495.
Authors: Vijay Kunadian; Alaide Chieffo; Paolo G Camici; Colin Berry; Javier Escaned; Angela H E M Maas; Eva Prescott; Nicole Karam; Yolande Appelman; Chiara Fraccaro; Gill Louise Buchanan; Stephane Manzo-Silberman; Rasha Al-Lamee; Evelyn Regar; Alexandra Lansky; J Dawn Abbott; Lina Badimon; Dirk J Duncker; Roxana Mehran; Davide Capodanno; Andreas Baumbach Journal: Eur Heart J Date: 2020-10-01 Impact factor: 29.983
Authors: Charis G McNabney; Stephanie L Sellers; Ryan J A Wilson; Shmuel Hart; Samuel A Rosenblatt; Darra T Murphy; Philipp Blanke; Amir A Ahmadi; Jaydeep Halankar; Adrian Attinger-Toller; Marcelo Godoy Zamorano; Janice Wong Li Yu; Bjarne L Nørgaard; Jonathon A Leipsic; Jonathan R Weir-McCall Journal: Radiol Cardiothorac Imaging Date: 2019-06-27