Long-term outcomes after fractional flow reserve-guided percutaneous coronary intervention in patients with severe coronary stenosis

Ying Hua Zhang, Jing Li, Andreas J. Flammer, Yoshiki Matsuo, Moo Sik Lee, Ryan J. Lennon, Malcolm R. Bell, David R. Holmes, John F. Bresnahan, Charanjit S. Rihal, Lilach O. Lerman, Amir Lerman

Research output: Contribution to journalArticle

Abstract

Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (FFR) assessment from 2002 to 2009, we identified 167 patients in whom FFR was measured in at least one 70%-89% stenotic lesion. These patients were subdivided into an FFR-defer group (n = 49) if PCI was deferred (FFR > 0.80), and an FFR-perform group (n = 118) if PCI was performed (FFR ≤ 0.80). Comparatively, an additional 1176 patients undergoing PCI in at least one lesion with 70%-89% stenosis but without measurement of FFR served as a control (angiography- guided) group. Clinical outcomes were compared during a median follow-up of 49.0 months. The 5-year Kaplan-Meier estimated revascularization rates were 16% in the FFR-defer group and 33% in the FFR-perform group (P = 0.046). The incidence of major adverse cardiac events were comparable in these two groups (HR = 0.82, 95% CI: 0.37-1.82, P = 0.63). The number of stents placed was significantly lower in the FFR-guided group (0.9 ± 0.8 vs. 1.4 ± 0.8, P < 0.001). Conclusions Functional revascularization for lesions with visually severe stenosis is clinically safe and associated with fewer stents use. This study suggests that extending the use of FFR to more severe coronary lesions may be reasonable.

Original languageEnglish (US)
Pages (from-to)329-337
Number of pages9
JournalJournal of Geriatric Cardiology
Volume16
Issue number4
DOIs
StatePublished - Jan 1 2019

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Coronary Stenosis
Percutaneous Coronary Intervention
Pathologic Constriction
Stents
Angiography
Safety
Incidence

Keywords

  • Fractional flow reserve
  • Outcome
  • Percutaneous coronary intervention
  • Severe stenosis
  • Stent

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Cardiology and Cardiovascular Medicine

Cite this

Long-term outcomes after fractional flow reserve-guided percutaneous coronary intervention in patients with severe coronary stenosis. / Zhang, Ying Hua; Li, Jing; Flammer, Andreas J.; Matsuo, Yoshiki; Lee, Moo Sik; Lennon, Ryan J.; Bell, Malcolm R.; Holmes, David R.; Bresnahan, John F.; Rihal, Charanjit S.; Lerman, Lilach O.; Lerman, Amir.

In: Journal of Geriatric Cardiology, Vol. 16, No. 4, 01.01.2019, p. 329-337.

Research output: Contribution to journalArticle

Zhang, Ying Hua ; Li, Jing ; Flammer, Andreas J. ; Matsuo, Yoshiki ; Lee, Moo Sik ; Lennon, Ryan J. ; Bell, Malcolm R. ; Holmes, David R. ; Bresnahan, John F. ; Rihal, Charanjit S. ; Lerman, Lilach O. ; Lerman, Amir. / Long-term outcomes after fractional flow reserve-guided percutaneous coronary intervention in patients with severe coronary stenosis. In: Journal of Geriatric Cardiology. 2019 ; Vol. 16, No. 4. pp. 329-337.
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abstract = "Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (FFR) assessment from 2002 to 2009, we identified 167 patients in whom FFR was measured in at least one 70{\%}-89{\%} stenotic lesion. These patients were subdivided into an FFR-defer group (n = 49) if PCI was deferred (FFR > 0.80), and an FFR-perform group (n = 118) if PCI was performed (FFR ≤ 0.80). Comparatively, an additional 1176 patients undergoing PCI in at least one lesion with 70{\%}-89{\%} stenosis but without measurement of FFR served as a control (angiography- guided) group. Clinical outcomes were compared during a median follow-up of 49.0 months. The 5-year Kaplan-Meier estimated revascularization rates were 16{\%} in the FFR-defer group and 33{\%} in the FFR-perform group (P = 0.046). The incidence of major adverse cardiac events were comparable in these two groups (HR = 0.82, 95{\%} CI: 0.37-1.82, P = 0.63). The number of stents placed was significantly lower in the FFR-guided group (0.9 ± 0.8 vs. 1.4 ± 0.8, P < 0.001). Conclusions Functional revascularization for lesions with visually severe stenosis is clinically safe and associated with fewer stents use. This study suggests that extending the use of FFR to more severe coronary lesions may be reasonable.",
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T1 - Long-term outcomes after fractional flow reserve-guided percutaneous coronary intervention in patients with severe coronary stenosis

AU - Zhang, Ying Hua

AU - Li, Jing

AU - Flammer, Andreas J.

AU - Matsuo, Yoshiki

AU - Lee, Moo Sik

AU - Lennon, Ryan J.

AU - Bell, Malcolm R.

AU - Holmes, David R.

AU - Bresnahan, John F.

AU - Rihal, Charanjit S.

AU - Lerman, Lilach O.

AU - Lerman, Amir

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (FFR) assessment from 2002 to 2009, we identified 167 patients in whom FFR was measured in at least one 70%-89% stenotic lesion. These patients were subdivided into an FFR-defer group (n = 49) if PCI was deferred (FFR > 0.80), and an FFR-perform group (n = 118) if PCI was performed (FFR ≤ 0.80). Comparatively, an additional 1176 patients undergoing PCI in at least one lesion with 70%-89% stenosis but without measurement of FFR served as a control (angiography- guided) group. Clinical outcomes were compared during a median follow-up of 49.0 months. The 5-year Kaplan-Meier estimated revascularization rates were 16% in the FFR-defer group and 33% in the FFR-perform group (P = 0.046). The incidence of major adverse cardiac events were comparable in these two groups (HR = 0.82, 95% CI: 0.37-1.82, P = 0.63). The number of stents placed was significantly lower in the FFR-guided group (0.9 ± 0.8 vs. 1.4 ± 0.8, P < 0.001). Conclusions Functional revascularization for lesions with visually severe stenosis is clinically safe and associated with fewer stents use. This study suggests that extending the use of FFR to more severe coronary lesions may be reasonable.

AB - Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (FFR) assessment from 2002 to 2009, we identified 167 patients in whom FFR was measured in at least one 70%-89% stenotic lesion. These patients were subdivided into an FFR-defer group (n = 49) if PCI was deferred (FFR > 0.80), and an FFR-perform group (n = 118) if PCI was performed (FFR ≤ 0.80). Comparatively, an additional 1176 patients undergoing PCI in at least one lesion with 70%-89% stenosis but without measurement of FFR served as a control (angiography- guided) group. Clinical outcomes were compared during a median follow-up of 49.0 months. The 5-year Kaplan-Meier estimated revascularization rates were 16% in the FFR-defer group and 33% in the FFR-perform group (P = 0.046). The incidence of major adverse cardiac events were comparable in these two groups (HR = 0.82, 95% CI: 0.37-1.82, P = 0.63). The number of stents placed was significantly lower in the FFR-guided group (0.9 ± 0.8 vs. 1.4 ± 0.8, P < 0.001). Conclusions Functional revascularization for lesions with visually severe stenosis is clinically safe and associated with fewer stents use. This study suggests that extending the use of FFR to more severe coronary lesions may be reasonable.

KW - Fractional flow reserve

KW - Outcome

KW - Percutaneous coronary intervention

KW - Severe stenosis

KW - Stent

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