Relation between fractional flow reserve value of coronary lesions with deferred revascularization and cardiovascular outcomes in non-diabetic and diabetic patients

Zhi Liu, Yasushi Matsuzawa, Joerg Herrmann, Jing Li, Ryan J. Lennon, Daniel J. Crusan, Taek Geun Kwon, Ming Zhang, Tao Sun, Shiwei Yang, Rajiv Gulati, Malcolm R. Bell, Lilach O Lerman, Amir Lerman

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background FFR of deferred PCI lesions can predict future cardiovascular events. However, the prognostic utility of FFR remains unclear in diabetic patients in view of the potential impact of the diffuse nature of vascular disease process. We aimed to study the relation between fractional flow reserve (FFR) values and long-term outcomes of diabetic and non-diabetic patients with deferred percutaneous coronary intervention (PCI). Methods Patients with FFR assessment and deferred PCI (n = 630) were enrolled and stratified according to diabetes mellitus (DM) status and FFR values. Patients were followed over a median of 39 months. Cox proportional hazard regression models were used to analyze the association between clinical endpoints and clinical factors such as DM and FFR. Results In non-diabetics (n = 450), higher FFR values were associated with less cardiovascular events (hazard ratio (HR) for death and myocardial infarction (MI) [95% confidence interval (CI)], 0.61[0.44 to 0.86] per 0.1 increase in FFR, p = 0.007; HR for revascularization [95%CI], 0.66[0.49 to 0.9] per 0.1 increase in FFR, p = 0.006). In diabetics (n = 180), there was no difference in death and MI across the range of FFR values. Among those patients with an FFR > 0.85, diabetics had a more than two-fold higher risk of death and MI than non-diabetics (HR [95% CI], 2.20 [1.19 to 4.01], p = 0.015). Conclusion Among non-diabetic patients with deferred PCI, a higher FFR was associated with lower rates of death, MI and revascularization. On the contrary in diabetic patients with deferred revascularization, FFR was not able to differentiate the risk of cardiovascular events.

Original languageEnglish (US)
Pages (from-to)56-62
Number of pages7
JournalInternational Journal of Cardiology
Volume219
DOIs
StatePublished - Sep 15 2016

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Percutaneous Coronary Intervention
Myocardial Infarction
Confidence Intervals
Diabetes Mellitus
Myocardial Revascularization
Vascular Diseases
Proportional Hazards Models
Mortality

Keywords

  • Deferred revascularization
  • Diabetes mellitus
  • Fractional flow reserve
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relation between fractional flow reserve value of coronary lesions with deferred revascularization and cardiovascular outcomes in non-diabetic and diabetic patients. / Liu, Zhi; Matsuzawa, Yasushi; Herrmann, Joerg; Li, Jing; Lennon, Ryan J.; Crusan, Daniel J.; Kwon, Taek Geun; Zhang, Ming; Sun, Tao; Yang, Shiwei; Gulati, Rajiv; Bell, Malcolm R.; Lerman, Lilach O; Lerman, Amir.

In: International Journal of Cardiology, Vol. 219, 15.09.2016, p. 56-62.

Research output: Contribution to journalArticle

Liu, Zhi ; Matsuzawa, Yasushi ; Herrmann, Joerg ; Li, Jing ; Lennon, Ryan J. ; Crusan, Daniel J. ; Kwon, Taek Geun ; Zhang, Ming ; Sun, Tao ; Yang, Shiwei ; Gulati, Rajiv ; Bell, Malcolm R. ; Lerman, Lilach O ; Lerman, Amir. / Relation between fractional flow reserve value of coronary lesions with deferred revascularization and cardiovascular outcomes in non-diabetic and diabetic patients. In: International Journal of Cardiology. 2016 ; Vol. 219. pp. 56-62.
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abstract = "Background FFR of deferred PCI lesions can predict future cardiovascular events. However, the prognostic utility of FFR remains unclear in diabetic patients in view of the potential impact of the diffuse nature of vascular disease process. We aimed to study the relation between fractional flow reserve (FFR) values and long-term outcomes of diabetic and non-diabetic patients with deferred percutaneous coronary intervention (PCI). Methods Patients with FFR assessment and deferred PCI (n = 630) were enrolled and stratified according to diabetes mellitus (DM) status and FFR values. Patients were followed over a median of 39 months. Cox proportional hazard regression models were used to analyze the association between clinical endpoints and clinical factors such as DM and FFR. Results In non-diabetics (n = 450), higher FFR values were associated with less cardiovascular events (hazard ratio (HR) for death and myocardial infarction (MI) [95{\%} confidence interval (CI)], 0.61[0.44 to 0.86] per 0.1 increase in FFR, p = 0.007; HR for revascularization [95{\%}CI], 0.66[0.49 to 0.9] per 0.1 increase in FFR, p = 0.006). In diabetics (n = 180), there was no difference in death and MI across the range of FFR values. Among those patients with an FFR > 0.85, diabetics had a more than two-fold higher risk of death and MI than non-diabetics (HR [95{\%} CI], 2.20 [1.19 to 4.01], p = 0.015). Conclusion Among non-diabetic patients with deferred PCI, a higher FFR was associated with lower rates of death, MI and revascularization. On the contrary in diabetic patients with deferred revascularization, FFR was not able to differentiate the risk of cardiovascular events.",
keywords = "Deferred revascularization, Diabetes mellitus, Fractional flow reserve, Prognosis",
author = "Zhi Liu and Yasushi Matsuzawa and Joerg Herrmann and Jing Li and Lennon, {Ryan J.} and Crusan, {Daniel J.} and Kwon, {Taek Geun} and Ming Zhang and Tao Sun and Shiwei Yang and Rajiv Gulati and Bell, {Malcolm R.} and Lerman, {Lilach O} and Amir Lerman",
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T1 - Relation between fractional flow reserve value of coronary lesions with deferred revascularization and cardiovascular outcomes in non-diabetic and diabetic patients

AU - Liu, Zhi

AU - Matsuzawa, Yasushi

AU - Herrmann, Joerg

AU - Li, Jing

AU - Lennon, Ryan J.

AU - Crusan, Daniel J.

AU - Kwon, Taek Geun

AU - Zhang, Ming

AU - Sun, Tao

AU - Yang, Shiwei

AU - Gulati, Rajiv

AU - Bell, Malcolm R.

AU - Lerman, Lilach O

AU - Lerman, Amir

PY - 2016/9/15

Y1 - 2016/9/15

N2 - Background FFR of deferred PCI lesions can predict future cardiovascular events. However, the prognostic utility of FFR remains unclear in diabetic patients in view of the potential impact of the diffuse nature of vascular disease process. We aimed to study the relation between fractional flow reserve (FFR) values and long-term outcomes of diabetic and non-diabetic patients with deferred percutaneous coronary intervention (PCI). Methods Patients with FFR assessment and deferred PCI (n = 630) were enrolled and stratified according to diabetes mellitus (DM) status and FFR values. Patients were followed over a median of 39 months. Cox proportional hazard regression models were used to analyze the association between clinical endpoints and clinical factors such as DM and FFR. Results In non-diabetics (n = 450), higher FFR values were associated with less cardiovascular events (hazard ratio (HR) for death and myocardial infarction (MI) [95% confidence interval (CI)], 0.61[0.44 to 0.86] per 0.1 increase in FFR, p = 0.007; HR for revascularization [95%CI], 0.66[0.49 to 0.9] per 0.1 increase in FFR, p = 0.006). In diabetics (n = 180), there was no difference in death and MI across the range of FFR values. Among those patients with an FFR > 0.85, diabetics had a more than two-fold higher risk of death and MI than non-diabetics (HR [95% CI], 2.20 [1.19 to 4.01], p = 0.015). Conclusion Among non-diabetic patients with deferred PCI, a higher FFR was associated with lower rates of death, MI and revascularization. On the contrary in diabetic patients with deferred revascularization, FFR was not able to differentiate the risk of cardiovascular events.

AB - Background FFR of deferred PCI lesions can predict future cardiovascular events. However, the prognostic utility of FFR remains unclear in diabetic patients in view of the potential impact of the diffuse nature of vascular disease process. We aimed to study the relation between fractional flow reserve (FFR) values and long-term outcomes of diabetic and non-diabetic patients with deferred percutaneous coronary intervention (PCI). Methods Patients with FFR assessment and deferred PCI (n = 630) were enrolled and stratified according to diabetes mellitus (DM) status and FFR values. Patients were followed over a median of 39 months. Cox proportional hazard regression models were used to analyze the association between clinical endpoints and clinical factors such as DM and FFR. Results In non-diabetics (n = 450), higher FFR values were associated with less cardiovascular events (hazard ratio (HR) for death and myocardial infarction (MI) [95% confidence interval (CI)], 0.61[0.44 to 0.86] per 0.1 increase in FFR, p = 0.007; HR for revascularization [95%CI], 0.66[0.49 to 0.9] per 0.1 increase in FFR, p = 0.006). In diabetics (n = 180), there was no difference in death and MI across the range of FFR values. Among those patients with an FFR > 0.85, diabetics had a more than two-fold higher risk of death and MI than non-diabetics (HR [95% CI], 2.20 [1.19 to 4.01], p = 0.015). Conclusion Among non-diabetic patients with deferred PCI, a higher FFR was associated with lower rates of death, MI and revascularization. On the contrary in diabetic patients with deferred revascularization, FFR was not able to differentiate the risk of cardiovascular events.

KW - Deferred revascularization

KW - Diabetes mellitus

KW - Fractional flow reserve

KW - Prognosis

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