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- Title
Angiographic Findings and Post–Percutaneous Coronary Intervention Fractional Flow Reserve.
- Authors
Zhang, Jinlong; Hwang, Doyeon; Yang, Seokhun; Hu, Xinyang; Lee, Joo Myung; Nam, Chang-Wook; Shin, Eun-Seok; Doh, Joon-Hyung; Hoshino, Masahiro; Hamaya, Rikuta; Kanaji, Yoshihisa; Murai, Tadashi; Zhang, Jun-Jie; Ye, Fei; Li, Xiaobo; Ge, Zhen; Chen, Shao-Liang; Kakuta, Tsunekazu; Wang, Jian'an; Koo, Bon-Kwon
- Abstract
Key Points: Question: Are there associations of angiographic findings and post–percutaneous coronary intervention (PCI) fractional flow reserve (FFR) and residual functional disease burden, and are they associated with cardiac outcomes? Findings: In this cohort study of 2147 patients from the International Post-PCI FFR registry, poor associations were observed between angiographic and physiologic parameters after PCI. Post-PCI FFR, unlike angiographic parameters, was associated with clinical events and the distribution of clinical events. Meaning: These findings suggest that angiographic assessment of post-PCI state may not provide relevant physiologic and clinical insights after PCI, but post-PCI physiologic assessment can offer valuable information about future clinical events and their distribution. This cohort study evaluates the association of angiographic findings and post–percutaneous coronary intervention (PCI) physiologic parameters according to residual functional disease burden among patients undergoing second-generation drug-eluting stent implantation. Importance: The associations between angiographic findings and post–percutaneous coronary intervention (PCI) fractional flow reserve (FFR) and their clinical relevance according to residual functional disease burden have not been thoroughly investigated. Objectives: To evaluate the association of angiographic and physiologic parameters according to residual functional disease burden after drug-eluting stent implantation. Design, Setting, and Participants: This cohort study population was from the International Post-PCI FFR registry, which incorporated 4 registries from Korea, China, and Japan. Patients who underwent angiographically successful second-generation drug-eluting stent implantation and post-PCI FFR measurement were included in the analysis. The patients were divided into 3 groups according to the residual disease burden (post-PCI FFR ≤0.80 [residual ischemia], 0.81-0.86 [suboptimal], and >0.86 [optimal]). The data were collected from August 23, 2018, to June 11, 2019, and the current analysis was performed from January 11, 2022, to October 7, 2023. Exposures: Angiographic parameters and post-PCI FFR. Main Outcomes and Measures: The primary outcome was target vessel failure (TVF), defined as a composite of cardiac death, target vessel–related myocardial infarction, and target vessel revascularization (TVR) at 2 years. Results: In this cohort of 2147 patients, the mean (SD) age was 64.3 (10.0) years, and 1644 patients (76.6%) were men. Based on the post-PCI physiologic status, 269 patients (12.5%) had residual ischemia, 551 (25.7%) had suboptimal results, and 1327 (61.8%) had optimal results. Angiographic parameters had poor correlations with post-PCI FFR (r < 0.20). Post-PCI FFR was isolated from all angiographic parameters in the unsupervised hierarchical cluster analysis. Post-PCI FFR was associated with the occurrence of TVF (adjusted hazard ratio [AHR] per post-PCI FFR 0.01 increase, 0.94 [95% CI, 0.92-0.97]; P <.001), but angiographic parameters were not. The residual ischemia group had a significantly higher rate of TVF than the suboptimal group (AHR, 1.75 [95% CI, 1.08-2.83]; P =.02) and the optimal group (AHR, 2.94 [95% CI, 1.82-4.73]; P <.001). The TVR in the residual ischemia group was predominantly associated with TVR in the nonstented segment (14 [53.8%]), unlike the other 2 groups (3 [10.0%] in the suboptimal group and 13 [30.2%] in the optimal group). Conclusions and Relevance: In this cohort study of the International Post-PCI FFR registry, a low degree of associations were observed between angiographic and physiologic parameters after PCI. Post-PCI FFR, unlike angiographic parameters, was associated with clinical events and the distribution of clinical events. The current study supports the use of post-PCI FFR as a procedural quality metric and further prospective study is warranted.
- Subjects
MYOCARDIAL infarction; PEARSON correlation (Statistics); CLUSTER analysis (Statistics); RESEARCH funding; DATA analysis; CORONARY circulation; TREATMENT effectiveness; CHI-squared test; DESCRIPTIVE statistics; LONGITUDINAL method; MYOCARDIAL revascularization; KAPLAN-Meier estimator; PERCUTANEOUS coronary intervention; ANALYSIS of variance; STATISTICS; CORONARY angiography; PATIENT monitoring; CORONARY artery disease; CONFIDENCE intervals; CARDIAC arrest; DATA analysis software; DRUG-eluting stents; ALGORITHMS
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2418072
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.18072