Clinical Relevance of Functionally Insignificant Moderate Coronary Artery Stenosis Assessed by 3‐Vessel Fractional Flow Reserve Measurement

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Hiroaki Takashima¹  Hitoshi Matsuo²  Fei Ye³  Shaoliang Chen³  Xinyang Hu⁴  JianAn Wang⁴  Nobuhiro Tanaka⁵  Eun‐Seok Shin⁶  Jonghanne Park⁷  Doyeon Hwang⁷  Bon‐Kwon Koo⁷  Jinlong Zhang⁷  Joon‐Hyung Doh⁸  Chang‐Wook Nam⁹  Joo Myung Lee^1,10  Jiyan Chen^1,11  Junqing Yang^1,11  Hiroyoshi Yokoi^1,12  Yasutsugu Shiono^1,13  Takashi Akasaka^1,13 

[1] Department of Cardiology, Aichi Medical University, Nagakute, Japan;Department of Cardiology, Gifu Heart Center, Gifu, Japan;Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China;Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China;Department of Cardiology, Tokyo Medical University, Tokyo, Japan;Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea;Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea;Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea;Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea;Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea;Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China;Kokura Memorial Hospital, Kitakyuku, Japan;Wakayama Medical University, Wakayama, Japan;

关键词: coronary artery disease;    fractional flow reserve;    multivessel coronary artery disease;    physiology/function;    prognosis;   

DOI  :  10.1161/JAHA.117.008055

来源: DOAJ

【 摘 要 】

BackgroundUnderstanding of the risk conferred by functionally insignificant lesions in multiple coronary vessels is limited. We investigated the prognostic implications of coronary artery disease (CAD) based on 3‐vessel fractional flow reserve (FFR). Methods and ResultsA total of 1,136 patients underwent FFR measurement in the 3 major epicardial arteries. We defined vessels with “Moderate CAD” as vessels with FFR, 0.81 to 0.87. Patients were classified into Group 1: No apparent CAD (FFR>0.87 in all 3‐vessels); Group 2: Single‐vessel moderate CAD; Group 3: Multivessel moderate CAD; and Group 4: Functionally significant CAD (FFR≤0.80) in any vessel. The primary end point was 2‐year major adverse cardiac events, a composite of cardiac death, myocardial infarction, and ischemia‐driven revascularization. Forty‐three percent of patients had moderate CAD (Group 2: 403/1136, 35.5%; Group 3: 84/1136, 7.4%). The 2‐year risk of major adverse cardiac events was not significantly different between patients with single‐vessel moderate CAD and no apparent CAD (2.6 versus 2.6%; HR, 1.1; 95% confidence interval, 0.4%–2.8%; P=0.89). However, patients with multivessel moderate CAD were at significantly higher risk than Group 1 (7.4 versus 2.6%; hazard ratio, 3.3; 95% confidence interval, 1.1%–9.8%; P=0.03). The risk of major adverse cardiac events in patients with multivessel moderate CAD was comparable to that of patients with functionally significant CAD (hazard ratio, 1.2; 95% confidence interval, 0.5%–3.0%; P=0.67). In a multivariable regression model, multivessel moderate CAD was an independent predictor of greater risk of 2‐year major adverse cardiac events. ConclusionsGlobal physiologic assessment with FFR measurement of 3 vessels can identify multivessel moderate CAD. The prognostic implication of multivessel moderate CAD appears comparable to that of functionally significant CAD. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01621438.

【 授权许可】

Unknown