Ki Hong Choi1, Joo Myung Lee1, Bon-Kwon Koo2, Chang-Wook Nam3, Eun-Seok Shin4, Joon-Hyung Doh5, Tae-Min Rhee6, Doyeon Hwang6, Jonghanne Park6, Jinlong Zhang6, Kyung-Jin Kim7, Xinyang Hu8, Jianan Wang8, 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, Seoul, Korea. 2. Department of Internal Medicine and Cardiovascular Center; Seoul National University, Seoul, Korea; Institute on Aging, Seoul National University, Seoul, Korea. Electronic address: bkkoo@snu.ac.kr. 3. Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea. 4. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. 5. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. 6. Department of Internal Medicine and Cardiovascular Center; Seoul National University, Seoul, Korea. 7. Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea. 8. Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. 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, 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
OBJECTIVES: The aim of this study was to investigate the prognostic implication of functional incomplete revascularization (IR) and residual functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (rFSS) in comparison with 3-vessel fractional flow reserve (FFR) and residual SYNTAX score. BACKGROUND: IR is associated with poor clinical outcomes in patients who underwent percutaneous coronary intervention. METHODS: A total of 385 patients who underwent 3-vessel FFR measurement after stent implantation were included in this study. The rFSS was defined as residual SYNTAX score measured only in vessels with FFR ≤0.8. The study population was divided into the functional IR group (rFSS ≥1) and the functional complete revascularization (CR) group (rFSS = 0). The primary outcome was major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization) at 2 years. RESULTS: Functional CR was achieved in 283 patients (73.5%). At 2-year follow-up, the functional IR group showed a significantly higher risk for MACEs (functional IR vs. CR, 14.6% vs. 4.2%; hazard ratio: 4.09; 95% confidence interval: 1.82 to 9.21; p < 0.001) than the functional CR group. In a multivariate-adjusted model, functional IR was an independent predictor of MACEs (adjusted hazard ratio: 4.17; 95% confidence interval: 1.85 to 9.44; p < 0.001). The rFSS showed a significant association with estimated 2-year MACE rate (hazard ratio: 1.09 per 1-U increase; 95% confidence interval: 1.02 to 1.17; p = 0.018). When added to clinical risk factors, rFSS showed the highest integrated discrimination improvement value for MACEs (3.5%; p = 0.002) among 3-vessel FFR, residual SYNTAX score, and rFSS. CONCLUSIONS: Patients with functional IR showed significantly higher rate of 2-year MACEs than those with functional CR. A combined anatomic and physiological scoring system (rFSS) after stent implantation better discriminated the risk for adverse events than anatomic or physiological assessment alone. (Clinical Implication of 3-Vessel Fractional Flow Reserve [FFR]; NCT01621438).
OBJECTIVES: The aim of this study was to investigate the prognostic implication of functional incomplete revascularization (IR) and residual functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (rFSS) in comparison with 3-vessel fractional flow reserve (FFR) and residual SYNTAX score. BACKGROUND: IR is associated with poor clinical outcomes in patients who underwent percutaneous coronary intervention. METHODS: A total of 385 patients who underwent 3-vessel FFR measurement after stent implantation were included in this study. The rFSS was defined as residual SYNTAX score measured only in vessels with FFR ≤0.8. The study population was divided into the functional IR group (rFSS ≥1) and the functional complete revascularization (CR) group (rFSS = 0). The primary outcome was major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization) at 2 years. RESULTS: Functional CR was achieved in 283 patients (73.5%). At 2-year follow-up, the functional IR group showed a significantly higher risk for MACEs (functional IR vs. CR, 14.6% vs. 4.2%; hazard ratio: 4.09; 95% confidence interval: 1.82 to 9.21; p < 0.001) than the functional CR group. In a multivariate-adjusted model, functional IR was an independent predictor of MACEs (adjusted hazard ratio: 4.17; 95% confidence interval: 1.85 to 9.44; p < 0.001). The rFSS showed a significant association with estimated 2-year MACE rate (hazard ratio: 1.09 per 1-U increase; 95% confidence interval: 1.02 to 1.17; p = 0.018). When added to clinical risk factors, rFSS showed the highest integrated discrimination improvement value for MACEs (3.5%; p = 0.002) among 3-vessel FFR, residual SYNTAX score, and rFSS. CONCLUSIONS:Patients with functional IR showed significantly higher rate of 2-year MACEs than those with functional CR. A combined anatomic and physiological scoring system (rFSS) after stent implantation better discriminated the risk for adverse events than anatomic or physiological assessment alone. (Clinical Implication of 3-Vessel Fractional Flow Reserve [FFR]; NCT01621438).
Authors: Sakura Nagumo; Carlos Collet; Bjarne L Norgaard; Hiromasa Otake; Brian Ko; Bon-Kwon Koo; Jonathon Leipsic; Daniele Andreini; Ward Heggermont; Jesper M Jensen; Yu Takahashi; Abdul Ihdayhid; Zinlong Zhang; Emanuele Barbato; Michael Maeng; Takuya Mizukami; Jozef Bartunek; Adam Updegrove; Martin Penicka; Campbell Rogers; Charles Taylor; Bernard De Bruyne; Jeroen Sonck Journal: Clin Cardiol Date: 2021-03-03 Impact factor: 2.882