| Autor: |
Hoshino M; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Hamaya R; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan.; Harvard T.H. Chan School of Public Health Boston MA., Kanaji Y; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Kanno Y; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Hada M; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Yamaguchi M; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Sumino Y; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Hirano H; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Horie T; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Usui E; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Sugiyama T; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Murai T; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan., Lee T; Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan., Yonetsu T; Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan., Lee JM; Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea., Choi KH; Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea., Hwang D; Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea., Park J; Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.; Department of Internal Medicine Naju National Hospital Ministry of Health and Welfare Naju Korea., Jung JH; Sejong General Hospital Sejong Heart Institute Bucheon Korea., Kim HY; Department of Cardiovascular Medicine Chonnam National University Hospital Gwangju Korea., Jung HW; Department of Cardiology Daegu Catholic University Medical Center Daegu Korea., Cho YK; Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea., Yoon HJ; Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea., Song YB; Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea., Hahn JY; Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea., Doh JH; Department of Medicine Inje University Ilsan Paik Hospital Goyang South Korea., Nam CW; Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea., Shin ES; Division of Cardiology Ulsan Hospital Ulsan Korea.; Department of Cardiology Ulsan University Hospital University of Ulsan College of Medicine Ulsan South Korea., Hur SH; Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea., Mejía-Rentería H; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Lauri F; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Goto S; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Macaya F; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., McInerney A; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Gravina G; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Vera R; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Gonzalo N; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Jimenez-Quevedo P; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Nuñez-Gil I; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Salinas P; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Nombela-Franco L; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Del Trigo M; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Fernández-Ortiz A; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Macaya C; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain., Koo BK; Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.; Institute on Aging Seoul National University Seoul Korea., Escaned J; Cardiovascular Institute Hospital Clinico San Carlos Madrid Spain.; Centro Nacional de Investigaciónes Cardiovasculares Carlos III Madrid Spain., Kakuta T; Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan. |
| Abstrakt: |
Background Sex-specific differences may influence prognosis after deferred revascularization following fractional flow reserve (FFR) measurement. This study sought to investigate the sex differences in long-term prognosis of patients with deferred revascularization following FFR assessment. Methods and Results A total of 879 patients (879 vessels) with deferred revascularization with FFR >0.75 who underwent FFR and coronary flow reserve measurements were enrolled from 3 countries (Korea, Japan, and Spain). Long-term outcomes were assessed in 649 men and 230 women by the patient-oriented composite outcome (POCO, a composite of any death, any myocardial infarction, and any revascularization). We applied inverse-probability weighting based on propensity scores to account for differences at baseline between women and men (age, hyperlipidemia, diabetes mellitus, diameter stenosis, lesion length, multivessel disease, FFR, coronary flow reserve. The median follow-up duration was 1855 days (745-1855 days). Median FFR values were 0.88 (0.83-0.93) in men and 0.89 (0.85-0.94) in women, respectively. The occurrences of POCO were significantly high in men compared with that in women (10.5% versus 4.2%, P =0.007). Kaplan-Meier analysis revealed that women had a significantly lower risk of POCO (χ 2 =7.2, P =0.007). Multivariate COX proportional hazards regression analysis revealed that age, male, diabetes mellitus, diameter stenosis, lesion length, and coronary flow reserve were independent predictors of POCO. After applying IPW, the hazard ratio of males for POCO was 2.07 (95% CI, 1.07-4.04, P =0.032). Conclusions This large multinational study reveals that long-term outcome differs between women and men in favor of women after FFR-guided revascularization deferral. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT02186093. |
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