Long-term outcome after deferred revascularization due to negative fractional flow reserve in intermediate coronary lesions
© 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals, Inc..
OBJECTIVES: The aim was to assess long-term outcome after deferring intervention of coronary lesions with a fractional flow reserve (FFR) value of >0.80 in a real-world patient population and then to identify factors associated with deferred target lesion failure (DTLF).
BACKGROUND: Deferring coronary interventions of intermediate lesions based on FFR measurement is safe, irrespective of the extent of coronary artery disease. However, FFR values near the cut-off of >0.80 may have less favorable outcome.
METHODS: A retrospective analysis was performed in patients with deferred coronary intervention based on FFR value >0.80. The primary endpoint was DTLF, a composite of acute coronary syndrome (ACS) and any coronary revascularization, related to the initially deferred stenosis.
RESULTS: A total of 600 patients, mean age of 66 ± 10 years, and 751 coronary lesions with negative FFR values (mean 0.88 ± 0.04) were included. The mean follow-up was 27 ± 15 months. DTLF occurred in 44 patients (7.3%), revascularization in 42 (7%), and ACS without revascularization in 2 patients (0.3%). Patients with DTLF more often had diabetes mellitus, previous coronary artery bypass grafting, multivessel disease (MVD), and lower FFR at inclusion. Multivariable regression analysis showed that lower deferred FFR values [FFR 0.81-0.85: hazard ratio (HR) 2.79 (95% CI [confidence interval]; 1.46-5.32), p .002], MVD [HR 1.98 (95% CI; 1.05-3.75), p .036], distal lesions [HR 2.43 (95% CI; 1.29-4.57), p .006], and lesions located in a saphenous vein graft (SVG) [HR 6.35 (95% CI; 1.81-22.28), p .004] were independent predictors for DTLF.
CONCLUSIONS: The long-term rate of DTLF of initially deferred coronary lesions was 7.3%. Independent predictors for DTLF are lower deferred FFR value, the presence of MVD, distal lesions, and lesions in SVG.
| Errataetall: |
CommentIn: Catheter Cardiovasc Interv. 2021 Feb 1;97(2):257-258. - PMID 33587798 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:97 |
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| Enthalten in: |
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions - 97(2021), 2 vom: 01. Feb., Seite 247-256 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Weerts, Jerremy [VerfasserIn] |
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| Links: |
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| Themen: |
ACS/NSTEMI |
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| Anmerkungen: |
Date Completed 24.09.2021 Date Revised 24.09.2021 published: Print-Electronic CommentIn: Catheter Cardiovasc Interv. 2021 Feb 1;97(2):257-258. - PMID 33587798 Citation Status MEDLINE |
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| doi: |
10.1002/ccd.28753 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM30594889X |
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| 245 | 1 | 0 | |a Long-term outcome after deferred revascularization due to negative fractional flow reserve in intermediate coronary lesions |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 24.09.2021 | ||
| 500 | |a Date Revised 24.09.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Catheter Cardiovasc Interv. 2021 Feb 1;97(2):257-258. - PMID 33587798 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals, Inc. | ||
| 520 | |a OBJECTIVES: The aim was to assess long-term outcome after deferring intervention of coronary lesions with a fractional flow reserve (FFR) value of >0.80 in a real-world patient population and then to identify factors associated with deferred target lesion failure (DTLF) | ||
| 520 | |a BACKGROUND: Deferring coronary interventions of intermediate lesions based on FFR measurement is safe, irrespective of the extent of coronary artery disease. However, FFR values near the cut-off of >0.80 may have less favorable outcome | ||
| 520 | |a METHODS: A retrospective analysis was performed in patients with deferred coronary intervention based on FFR value >0.80. The primary endpoint was DTLF, a composite of acute coronary syndrome (ACS) and any coronary revascularization, related to the initially deferred stenosis | ||
| 520 | |a RESULTS: A total of 600 patients, mean age of 66 ± 10 years, and 751 coronary lesions with negative FFR values (mean 0.88 ± 0.04) were included. The mean follow-up was 27 ± 15 months. DTLF occurred in 44 patients (7.3%), revascularization in 42 (7%), and ACS without revascularization in 2 patients (0.3%). Patients with DTLF more often had diabetes mellitus, previous coronary artery bypass grafting, multivessel disease (MVD), and lower FFR at inclusion. Multivariable regression analysis showed that lower deferred FFR values [FFR 0.81-0.85: hazard ratio (HR) 2.79 (95% CI [confidence interval]; 1.46-5.32), p .002], MVD [HR 1.98 (95% CI; 1.05-3.75), p .036], distal lesions [HR 2.43 (95% CI; 1.29-4.57), p .006], and lesions located in a saphenous vein graft (SVG) [HR 6.35 (95% CI; 1.81-22.28), p .004] were independent predictors for DTLF | ||
| 520 | |a CONCLUSIONS: The long-term rate of DTLF of initially deferred coronary lesions was 7.3%. Independent predictors for DTLF are lower deferred FFR value, the presence of MVD, distal lesions, and lesions in SVG | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ACS/NSTEMI | |
| 650 | 4 | |a coronary angiography | |
| 650 | 4 | |a coronary artery disease | |
| 650 | 4 | |a coronary blood flow | |
| 650 | 4 | |a fractional flow reserve | |
| 650 | 4 | |a percutaneous coronary intervention | |
| 700 | 1 | |a Pustjens, Tobias |e verfasserin |4 aut | |
| 700 | 1 | |a Amin, Elsa |e verfasserin |4 aut | |
| 700 | 1 | |a Ilhan, Mustafa |e verfasserin |4 aut | |
| 700 | 1 | |a Veenstra, Leo F |e verfasserin |4 aut | |
| 700 | 1 | |a Theunissen, Ralph A L J |e verfasserin |4 aut | |
| 700 | 1 | |a Vainer, Jindrich |e verfasserin |4 aut | |
| 700 | 1 | |a Stein, Mera |e verfasserin |4 aut | |
| 700 | 1 | |a Ruiters, Lex A W |e verfasserin |4 aut | |
| 700 | 1 | |a Gho, Ben C G |e verfasserin |4 aut | |
| 700 | 1 | |a Van't Hof, Arnoud W J |e verfasserin |4 aut | |
| 700 | 1 | |a Rasoul, Saman |e verfasserin |4 aut | |
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