A prospective natural history study of coronary atherosclerosis using fractional flow reserve
| Autor: | Gabor G. Toth, Emanuele Barbato, Nick Curzen, Bernard De Bruyne, Nico H.J. Pijls, William F. Fearon, Gilles Rioufol, Zsolt Piroth, Pim A.L. Tonino, Peter Jüni, Nils P. Johnson |
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| Přispěvatelé: | Cardiovascular Biomechanics, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Barbato, Emanuele, Toth, Gg, Johnson, Np, Pijls, Nhj, Fearon, Wf, Tonino, Pal, Curzen, N, Piroth, Z, Rioufol, G, Juni, P, De Bruyne, B. |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty stable angina Percutaneous Time Factors [SDV]Life Sciences [q-bio] clinical outcome Fractional flow reserve Coronary Artery Disease 030204 cardiovascular system & hematology Coronary Angiography Severity of Illness Index vessel related Coronary artery disease 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Internal medicine medicine Humans 030212 general & internal medicine Prospective Studies cardiovascular diseases fractional flow reserve Coronary atherosclerosis business.industry Middle Aged medicine.disease Atherosclerosis Prognosis Coronary Vessels 3. Good health Surgery Fractional Flow Reserve Myocardial Stenosis Conventional PCI Cardiology Female Cardiology and Cardiovascular Medicine business Mace Natural history study Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology, 68(21), 2247-2255. Elsevier Journal of the American College of Cardiology Journal of the American College of Cardiology, Elsevier, 2016, 68 (21), pp.2247-2255. ⟨10.1016/j.jacc.2016.08.055⟩ |
| ISSN: | 0735-1097 |
| Popis: | International audience; BACKGROUND: In patients with coronary artery disease, clinical outcome depends on the extent of reversible myocardial ischemia. Whether the outcome also depends on the severity of the stenosis as determined by fractional flow reserve (FFR) remains unknown. OBJECTIVES: This study sought to investigate the relationship between FFR values and vessel-related clinical outcome. METHODS: We prospectively studied major adverse cardiovascular events (MACE) at 2 years in 607 patients in whom all stenoses were assessed by FFR and who were treated with medical therapy alone. The relationship between FFR and 2-year MACE was assessed as a continuous function. Logistic and Cox proportional hazards regression models were used to calculate the average decrease in the risk of MACE per 0.05-U increase in FFR. RESULTS: MACE occurred in 272 (26.5%) of 1,029 lesions. Target lesions with diameter stenosis \textgreater/=70% were more often present in the MACE group (p \textless 0.01). Median FFR was significantly lower in the MACE group versus the non-MACE group (0.68 [interquartile range: 0.54 to 0.77] vs. 0.80 [interquartile range: 0.70 to 0.88]; p \textless 0.01). The cumulative incidence of MACE significantly increased with increasing FFR quartiles. An average decrease in MACE per 0.05-unit increase in FFR was statistically significant even after adjustment for all clinical and angiographic features (odds ratio: 0.81; 95% confidence interval: 0.76 to 0.86]). The strongest increase in MACE occurred for FFR values between 0.80 and 0.60. In multivariable Cox regression analysis, FFR was significantly associated with MACE up to 2 years (hazard ratio: 0.87; 95% confidence interval: 0.83 to 0.91]). CONCLUSIONS: In patients with stable coronary disease, stenosis severity as assessed by FFR is a major and independent predictor of lesion-related outcome. (FAME II - Fractional Flow Reserve [FFR] Guided Percutaneous Coronary Intervention [PCI] Plus Optimal Medical Treatment [OMT] Verses OMT; NCT01132495). |
| Databáze: | OpenAIRE |
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