Медицинская библиотека · JACC. Asia · 2023

Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction.

Choi Ki Hong, Kwon Woochan, Shin Doosup, Lee Seung-Hun, Hwang Doyeon, Zhang Jinlong, Nam Chang-Wook, Shin Eun-Seok, Doh Joon-Hyung, Chen Shao-Liang, Kakuta Tsunekazu, Toth Gabor G, Piroth Zsolt, Hakeem Abdul, Uretsky Barry F, Hokama Yohei, Tanaka Nobuhiro, Lim Hong-Seok, Ito Tsuyoshi, Matsuo Akiko, Azzalini Lorenzo, Leesar Massoud A, Daemen Joost, Collison Damien, Collet Carlos, De Bruyne Bernard, Koo Bon-Kwon, Park Taek Kyu, Yang Jeong Hoon, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Gwon Hyeon-Cheol, Lee Joo Myung

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Аннотация

BACKGROUND

Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified.

OBJECTIVES

This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF).

METHODS

A total of 2,965 patients with available LVEF were selected from the POST-PCI FLOW (Prognostic Implications of Physiologic Investigation After Revascularization with Stent) international registry of patients with post-PCI FFR measurement. The primary outcome was a composite of cardiac death or target-vessel myocardial infarction (TVMI) at 2 years. The secondary outcome was target-vessel revascularization (TVR) and target vessel failure, which was a composite of cardiac death, TVMI, or TVR.

RESULTS

Post-PCI FFR was independently associated with the risk of target vessel failure (per 0.01 decrease: HRadj: 1.029; 95% CI: 1.009-1.049; P = 0.005). Post-PCI FFR was associated with increased risk of cardiac death or TVMI (HRadj: 1.145; 95% CI: 1.025-1.280; P = 0.017) among patients with LVEF ≤40%, and with that of TVR in patients with LVEF >40% (HRadj: 1.028; 95% CI: 1.005-1.052; P = 0.020). Post-PCI FFR ≤0.80 was associated with increased risk of cardiac death or TVMI in the LVEF ≤40% group and with that of TVR in LVEF >40% group. Prognostic impact of post-PCI FFR for the primary outcome was significantly different according to LVEF (Pinteraction = 0.019).

CONCLUSIONS

Post-PCI FFR had differential prognostic impact according to LVEF. Residual ischemia by post-PCI FFR ≤0.80 was a prognostic indicator for cardiac death or TVMI among patients with patients with LVEF ≤40%, and it was associated with TVR among patients with patients with LVEF>40%. (Prognostic Implications of Physiologic Investigation After Revascularization with Stent [POST-PCI FLOW]; NCT04684043).

Для цитирования: Choi Ki Hong, Kwon Woochan, Shin Doosup, Lee Seung-Hun, Hwang Doyeon, Zhang Jinlong, Nam Chang-Wook, Shin Eun-Seok, Doh Joon-Hyung, Chen Shao-Liang, Kakuta Tsunekazu, Toth Gabor G, Piroth Zsolt, Hakeem Abdul, Uretsky Barry F, Hokama Yohei, Tanaka Nobuhiro, Lim Hong-Seok, Ito Tsuyoshi, Matsuo Akiko, Azzalini Lorenzo, Leesar Massoud A, Daemen Joost, Collison Damien, Collet Carlos, De Bruyne Bernard, Koo Bon-Kwon, Park Taek Kyu, Yang Jeong Hoon, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Gwon Hyeon-Cheol, Lee Joo Myung. Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction.. JACC. Asia. 2023. DOI: 10.1016/j.jacasi.2023.10.009.

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