Joo Myung Lee1, Tae-Min Rhee2, Ki Hong Choi1, Jonghanne Park2,3, Doyeon Hwang2, Jinseob Kim4, Jinhyoung Park5, Hyung Yoon Kim6, Hae Won Jung7, Yun-Kyeong Cho8, Hyuck-Jun Yoon8, Young Bin Song1, Joo-Yong Hahn1, Chang-Wook Nam8, Eun-Seok Shin9,10, Joon-Hyung Doh11, Seung-Ho Hur8, Bon-Kwon Koo2,12. 1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine. 2. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital. 3. Department of Internal Medicine, Naju National Hospital, Ministry of Health and Welfare. 4. Department of Epidemiology, School of Public Health, Seoul National University. 5. Department of Biomedical Engineering, Sungkyunkwan University. 6. Department of Cardiovascular Medicine, Chonnam National University Hospital. 7. Department of Cardiology, Daegu Catholic University Medical Center. 8. Department of Medicine, Keimyung University Dongsan Medical Center. 9. Division of Cardiology, Ulsan Hospital. 10. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine. 11. Department of Medicine, Inje University Ilsan Paik Hospital. 12. Institute on Aging, Seoul National University.
Abstract
BACKGROUND: We evaluated the 2-year clinical outcomes of deferred lesions with discordant results between resting and hyperemic pressure-derived physiologic indices, including resting distal to aortic coronary pressure (resting Pd/Pa), instantaneous wave-free ratio (iFR), resting full-cycle ratio (RFR), diastolic pressure ratio (dPR), and fractional flow reserve (FFR).Methods and Results: The 2-year clinical outcomes of 1,024 vessels (435 patients) with available resting Pd/Pa, iFR, RFR, dPR, and FFR data were analyzed according to a 4-group classification using known cutoff values (resting Pd/Pa ≤0.92, iFR/RFR/dPR ≤0.89, and FFR ≤0.80): Group 1 (concordant normal), Group 2 (high resting index and low FFR), Group 3 (low resting index and high FFR), and Group 4 (concordance abnormal). The primary outcome was vessel-oriented composite outcomes (VOCO) in deferred vessels at 2 years. In the comparison of VOCO risk among 4 groups classified according to FFR and 4 resting physiologic indices, Group 4 consistently showed a significantly higher risk of VOCO than Group 1. Comparison of VOCO risk among 4 groups classified according to iFR and other resting physiologic indices also showed the same results. The presence of discordance, either between hyperemic and resting indices or among resting indices, was not an independent predictor for VOCO. CONCLUSIONS: Discordant results between resting physiologic indices and FFR and among the resting indices were not associated with increased risk of VOCO in deferred lesions.
BACKGROUND: We evaluated the 2-year clinical outcomes of deferred lesions with discordant results between resting and hyperemic pressure-derived physiologic indices, including resting distal to aortic coronary pressure (resting Pd/Pa), instantaneous wave-free ratio (iFR), resting full-cycle ratio (RFR), diastolic pressure ratio (dPR), and fractional flow reserve (FFR).Methods and Results: The 2-year clinical outcomes of 1,024 vessels (435 patients) with available resting Pd/Pa, iFR, RFR, dPR, and FFR data were analyzed according to a 4-group classification using known cutoff values (resting Pd/Pa ≤0.92, iFR/RFR/dPR ≤0.89, and FFR ≤0.80): Group 1 (concordant normal), Group 2 (high resting index and low FFR), Group 3 (low resting index and high FFR), and Group 4 (concordance abnormal). The primary outcome was vessel-oriented composite outcomes (VOCO) in deferred vessels at 2 years. In the comparison of VOCO risk among 4 groups classified according to FFR and 4 resting physiologic indices, Group 4 consistently showed a significantly higher risk of VOCO than Group 1. Comparison of VOCO risk among 4 groups classified according to iFR and other resting physiologic indices also showed the same results. The presence of discordance, either between hyperemic and resting indices or among resting indices, was not an independent predictor for VOCO. CONCLUSIONS: Discordant results between resting physiologic indices and FFR and among the resting indices were not associated with increased risk of VOCO in deferred lesions.
Authors: Tim P van de Hoef; Joo Myung Lee; Mauro Echavarria-Pinto; Bon-Kwon Koo; Hitoshi Matsuo; Manesh R Patel; Justin E Davies; Javier Escaned; Jan J Piek Journal: Nat Rev Cardiol Date: 2020-05-14 Impact factor: 32.419
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