Safety of FFR-guided revascularisation deferral in Anatomically prognostiC diseasE (FACE: CARDIOGROUP V STUDY): A prospective multicentre study
| Autor: | Massimo Mancone, Artur Dziewierz, Pierluigi Omedè, Rahim Kanji, Marcin Krakowian, Giuseppe Andò, Andrea Picchi, Alfonso Ielasi, Sergio Raposeiras-Roubín, Emmanuele Soraci, Simone Calcagno, Stefano Rigattieri, Claudio Moretti, Umberto Barbero, Miłosz Jaguszewski, Maurizio D'Amico, Víctor Alfonso Jiménez Díaz, Antonio Montefusco, Gianluca Campo, Francesco Gallo, Andrea Rognoni, Zenon Huczek, Roberto Verardi, Gennario Sardella, Mauro Rinaldi, Marco Francesco Lococo, Paweł Kleczyński, Mila Menozzi, Fabrizio D'Ascenzo, Enrico Cerrato, Javier Escaned, Massimo Fineschi, Fiorenzo Gaita |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty left main medicine.medical_treatment Renal function Coronary Artery Disease Fractional flow reserve 030204 cardiovascular system & hematology NO Lesion 03 medical and health sciences 0302 clinical medicine Angioplasty Internal medicine Myocardial Revascularization Clinical endpoint Humans Medicine Prospective Studies Registries 030212 general & internal medicine Myocardial infarction angioplasty chronic kidney disease fractional flow reserve cardiology and cardiovascular medicine Aged business.industry Middle Aged Prognosis medicine.disease Fractional Flow Reserve Myocardial Survival Rate Concomitant Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business Mace Follow-Up Studies |
| Zdroj: | International Journal of Cardiology. 270:107-112 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2018.06.013 |
| Popis: | FFR-guided coronary intervention is recommended for patients with intermediate stenoses. However, concerns exist with this approach in anatomically prognostic disease.In this prospective, multicentre study, we consecutively enrolled patients found to have FFR negative lesions in anatomically significant sites: left main; proximal LAD; last remaining patent vessel; and multiple vessels with concomitant impaired left ventricular systolic function (EF 40%). As per recommendation, revascularisation was deferred, and patients included into a registry. The primary endpoint was MACE (death, myocardial infarction and unplanned target lesion revascularization). Secondary endpoints were the above individual components. Subgroup analyses were performed for clinical presentation (stable vs. ACS), localization of lesion (ostial vs. non ostial) and renal function.The registry included 292 patients with 297 deferred stenoses. After 1-year, the primary endpoint occurred in 5% of patients, mainly driven by TLR (2.7%). Cardiovascular death occurred in 0.8% and AMI in 0.8%. During a follow-up of 22.2 ± 11 months, MACE occurred in 11.6%. Cardiovascular death occurred in 1.8% and AMI in 2.1%. After multivariate analysis, impaired renal function (OR 1.99; CI 95% 1.74-5.41; p = 0.046) and ostial disease (OR 2.88; CI 95% 1.04-7.38; p = 0.041) were found to be predictors of MACE. Impaired renal function also predicted TLR (OR 2.43; CI 95% 1.17-5.02; p = 0.017).FFR-guided revascularisation deferral is safe in the majority of anatomically prognostic disease. However, further evaluation is required in the risk stratification of those patients with ostial disease and renal disease. Registered on ClinicalTrials, NCT02590926. |
| Databáze: | OpenAIRE |
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