CBS 2019
CBSMD教育中心
English

科学研究

科研文章

荐读文献

Gut microbiota induces high platelet response in patients with ST segment elevation myocardial infarction after ticagrelor treatment Difference in basic concept of coronary bifurcation intervention between Korea and Japan. Insight from questionnaire in experts of Korean and Japanese bifurcation clubs Left main coronary artery disease: importance, diagnosis, assessment, and management Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis Diagnostic accuracy of fractional flow reserve from anatomic CT angiography Left Main Bifurcation Angioplasty: Are 2 Stents One Too Many? Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial Device specificity of vascular healing following implantation of bioresorbable vascular scaffolds and bioabsorbable polymer metallic drug-eluting stents in human coronary arteries: the ESTROFA OCT BVS vs. BP-DES study Nicotine promotes vascular calcification via intracellular Ca21-mediated, Nox5-induced oxidative stress, and extracellular vesicle release in vascular smooth muscle cells A randomized trial of bifurcation stenting technique in chronic total occlusions percutaneous coronary intervention

Original Research2018 Aug 13;11(15):1423-1433.

JOURNAL:JACC Cardiovasc Interv. Article Link

Prognostic Implication of Thermodilution Coronary Flow Reserve in Patients Undergoing Fractional Flow Reserve Measurement

Lee JM, Choi KH, Koo BK et al. Keywords: coronary artery disease; coronary flow reserve; fractional flow reserve; myocardial ischemia; percutaneous coronary intervention; prognosis

ABSTRACT


OBJECTIVES - This study investigated the prognostic implication of coronary flow reserve (CFR) in patients who underwent fractional flow reserve (FFR) measurement.


BACKGROUNDLimited data are available regarding the long-term prognosis associated with thermodilution CFR in patients with coronary artery disease.


METHODSA total of 519 patients (737 vessels) who did not undergo revascularization were classified according to FFR and CFR values. Low FFR and low CFR were defined with upper thresholds of 0.8 and 2.0, respectively. FFR and CFR were measured by a pressure-temperature sensor-tipped wire. Clinical outcomes were assessed by the vessel-oriented composite outcome (VOCO) (a composite of cardiac death, vessel-specific myocardial infarction, and vessel-specific revascularization) during 5 years of follow-up.


RESULTSThe categorical agreement (kappa = 0.080; p = 0.024) between FFR and CFR were modest, and 30.6% of the population showed discordant results between FFR and CFR. During 5 years of follow-up, patients with low CFR had a significantly higher risk of VOCO than did those with high CFR (hazard ratio [HR]: 3.171; 95% CI: 1.664 to 6.042; p < 0.001). Among patients with high FFR, there were no differences in clinical risk factor profiles, FFR, or stenosis severity between the high-CFR and low-CFR groups, and low CFR was an independent predictor for VOCO (HR: 4.999; 95% CI: 2.104 to 11.879; p < 0.001). In a 4-group classification according to both FFR and CFR, patients with low FFR and low CFR had the highest risk of VOCO (17.9%; overall p < 0.001).


CONCLUSIONSPatients with low CFR had a significantly higher risk of clinical events during 5 years of follow-up. Low CFR was an independent predictor for patient-oriented composite outcome among patients with high FFR. These results support the value of CFR in patients who undergo FFR measurement. (Clinical, Physical and Prognostic Implication of Microvascular Status; NCT02186093).


Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.