Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes.

Autor:	Escaned J; Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain., Ryan N; Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain., Mejía-Rentería H; Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain., Cook CM; Hammersmith Hospital, Imperial College London, London, United Kingdom., Dehbi HM; CRUK & UCL Cancer Trials Centre, University College London, London, United Kingdom., Alegria-Barrero E; Hospital Universitario de Torrejón and Universidad Francisco de Vitoria, Madrid, Spain., Alghamdi A; King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi Arabia., Al-Lamee R; Hammersmith Hospital, Imperial College London, London, United Kingdom., Altman J; Colorado Heart and Vascular, Lakewood, Colorado., Ambrosia A; Mesa, Arizona., Baptista SB; Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal., Bertilsson M; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden., Bhindi R; Royal North Shore Hospital, Sydney, Australia., Birgander M; Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden., Bojara W; Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz, Germany., Brugaletta S; Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain., Buller C; St. Michaels Hospital, Toronto, Ontario, Canada., Calais F; Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden., Silva PC; Hospital Santa Maria, Lisbon, Portugal., Carlsson J; Kalmar County Hospital, and Linnaeus University, Faculty of Health and Life Sciences, Kalmar, Sweden., Christiansen EH; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Danielewicz M; Department of Cardiology, Karlstad Hospital, Karlstad, Sweden., Di Mario C; Royal Brompton Hospital, Imperial College London, United Kingdom, and University of Florence, Florence, Italy., Doh JH; Inje University Ilsan Paik Hospital, Daehwa-Dong, South Korea., Erglis A; Pauls Stradins Clinical University Hospital, Riga, Latvia., Erlinge D; Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden., Gerber RT; Conquest Hospital, St. Leonards-on-Sea, United Kingdom., Going O; Sana Klinikum Lichtenberg, Lichtenberg, Germany., Gudmundsdottir I; Department of Cardiology, Reykjavik University Hospital, Reykjavik, Iceland., Härle T; Klinikum Oldenburg, European Medical School, Carl von Ossietzky University, Oldenburg, Germany., Hauer D; Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden., Hellig F; Sunninghill Hospital, Johannesburg, South Africa., Indolfi C; University Magna Graecia, Catanzaro, Italy., Jakobsen L; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Janssens L; Imelda Hospital, Bonheiden, Belgium., Jensen J; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Cardiology, Capio S:t Görans Sjukhus, Stockholm, and Department of Medicine, Sundsvall Hospital, Sundsvall, Sweden., Jeremias A; Stony Brook University Medical Center, Stony Brook, New York., Kåregren A; Department of Internal Medicine, Västmanland Hospital Västerås, Västerås, Sweden., Karlsson AC; Department of Cardiology, Halmstad Hospital, Halmstad, Sweden., Kharbanda RK; John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, United Kingdom., Khashaba A; Ain Shams University, Cairo, Egypt., Kikuta Y; Fukuyama Cardiovascular Hospital, Fukuyama, Japan., Krackhardt F; Charite Campus Virchow Klinikum, Universitaetsmedizin, Berlin, Germany., Koo BK; Seoul National University Hospital, Seoul, South Korea., Koul S; Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden., Laine M; Helsinki University Hospital, Helsinki, Finland., Lehman SJ; Flinders University, Adelaide, Australia., Lindroos P; Department of Cardiology, St. Göran Hospital, Stockholm, Sweden., Malik IS; Hammersmith Hospital, Imperial College London, London, United Kingdom., Maeng M; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Matsuo H; Gifu Heart Center, Gifu, Japan., Meuwissen M; Amphia Hospital, Breda, the Netherlands., Nam CW; Keimyung University Dongsan Medical Center, Daegu, South Korea., Niccoli G; Catholic University of the Sacred Heart, Rome, Italy., Nijjer SS; Hammersmith Hospital, Imperial College London, London, United Kingdom., Olsson H; Department of Cardiology, Karlstad Hospital, Karlstad, Sweden., Olsson SE; Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden., Omerovic E; Department of Cardiology, Sahlgrenska University Gothenburg, Sweden., Panayi G; Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden., Petraco R; Hammersmith Hospital, Imperial College London, London, United Kingdom., Piek JJ; AMC Heart Center, Academic Medical Center, Amsterdam, the Netherlands., Ribichini F; University Hospital Verona, Verona, Italy., Samady H; Emory University, Atlanta, Georgia., Samuels B; Cedars-Sinai Heart Institute, Los Angeles, California., Sandhall L; Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden., Sapontis J; MonashHeart and Monash University, Melbourne, Australia., Sen S; Hammersmith Hospital, Imperial College London, London, United Kingdom., Seto AH; Veterans Affairs Long Beach Healthcare System, Long Beach, California., Sezer M; Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey., Sharp ASP; Royal Devon and Exeter Hospital and University of Exeter, Exeter, United Kingdom., Shin ES; Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea., Singh J; Washington University School of Medicine, St. Louis, Missouri., Takashima H; Aichi Medical University Hospital, Aichi, Japan., Talwar S; Royal Bournemouth General Hospital, Bournemouth, United Kingdom., Tanaka N; Tokyo Medical University, Tokyo, Japan., Tang K; Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, United Kingdom., Van Belle E; Institut Coeur Poumon, Lille University Hospital, and INSERM Unité 1011, Lille, France., van Royen N; VU University Medical Center, Amsterdam, the Netherlands., Varenhorst C; Department of Medical Sciences, Uppsala University, Uppsala, Sweden., Vinhas H; Hospital Garcia de Horta, Lisbon, Portugal., Vrints CJ; Antwerp University Hospital, Antwerp, Belgium., Walters D; Prince Charles Hospital, Brisbane, Australia., Yokoi H; Fukuoka Sannou Hospital, Fukuoka, Japan., Fröbert O; Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden., Patel MR; Duke University, Durham, North Carolina., Serruys P; Department of Cardiology, Imperial College London, London, United Kingdom., Davies JE; Hammersmith Hospital, Imperial College London, London, United Kingdom. Electronic address: justindavies@heart123.com., Götberg M; Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2018 Aug 13; Vol. 11 (15), pp. 1437-1449.
DOI:	10.1016/j.jcin.2018.05.029
Abstrakt:	Objectives: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). Background: Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. Methods: The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. Results: Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). Conclusions: Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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