Safety of coronary revascularization deferral based on fractional flow reserve and instantaneous wave-free ratio in patients with chronic kidney disease
| Autor: | Hernán Mejía-Rentería, Nieves Gonzalo, María José Pérez-Vizcayno, Alejandro Travieso, Pablo Salinas, Alex F Castro-Mejía, Fernando Macaya, Javier Escaned, Pilar Jiménez-Quevedo, Adrian Jeronimo-Baza, Gabriela Tirado-Conte, Iván J. Núñez-Gil, Antonio Fernández-Ortiz, Luis Nombela |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Myocardial Infarction Renal function Fractional flow reserve Coronary Artery Disease urologic and male genital diseases Revascularization Risk Factors Internal medicine medicine Clinical endpoint Myocardial Revascularization Humans Myocardial infarction Instantaneous wave-free ratio Renal Insufficiency Chronic Retrospective Studies business.industry Hazard ratio General Medicine medicine.disease female genital diseases and pregnancy complications Fractional Flow Reserve Myocardial Treatment Outcome Cardiology Cardiology and Cardiovascular Medicine business Kidney disease |
| Zdroj: | Cardiology journal. 29(4) |
| ISSN: | 1898-018X |
| Popis: | Background: The safety of revascularization deferral according to pressure wire examination in patients with chronic kidney disease (CKD) has not been fully established. Methods: From a retrospective cohort of 439 patients in whom revascularization was deferred after physiological assessment, we examined the incidence of patient-oriented composite endpoint (POCE: all-cause death, myocardial infarction [MI] and unplanned revascularization) in patients with CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m 2 ) and without it. Results: At 4 years of follow-up, the primary endpoint was met by 25.0% of patients with CKD and by 14.4% of patients without CKD (hazard ratio [HR] 1.56, 95% confidence interval [CI] 0.96–2.53, p = 0.071). The incidence of POCE was even higher in patients with an eGFR < 30 mL/min/1.73 m 2 : 43.8% (HR 3.10, 95% CI 1.08–8.92, p = 0.036). However, no differences were observed in the incidence of MI (4.2% vs. 4.4% in non-CKD), target vessel revascularization (5.8% vs. 5.9%), and target vessel MI (0.8% vs. 4.6%). Conclusions: Patients with CKD in whom pressure-wire evaluation led to deferral of coronary revascularization develop more POCE in the long term, compared to patients with normal renal function. However, the increase in POCE in patients with CKD was seldom related to deferred vessels, thus suggesting an epiphenomenon of an intrinsically higher cardiovascular risk of CKD patients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|