한빛사논문
- 조회374
Jinlong Zhang, MD, PhD1; Doyeon Hwang, MD2; Seokhun Yang, MD2; Xinyang Hu, MD, PhD1; Joo Myung Lee, MD, MPH, PhD3; Chang-Wook Nam, MD, PhD4; Eun-Seok Shin, MD, PhD5; Joon-Hyung Doh, MD, PhD6; Masahiro Hoshino, MD7; Rikuta Hamaya, MD7; Yoshihisa Kanaji, MD, PhD7; Tadashi Murai, MD, PhD7; Jun-Jie Zhang, PhD8; Fei Ye, MD8; Xiaobo Li, MD8; Zhen Ge, MD8; Shao-Liang Chen, MD, PhD8; Tsunekazu Kakuta, MD, PhD7; Jian’an Wang, MD, PhD1; Bon-Kwon Koo, MD, PhD2
1Department of Cardiology, Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
2Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
3Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
4Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
5Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
6Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea
7Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
8Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
Drs J. Zhang and Hwang equally contributed as first authors.
Corresponding Author: Bon-Kwon Koo, MD, PhD
Abstract
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.
논문정보
- Research article
- 2024년 06월 (BRIC 등록일 2024-06-24)
- 국내(교신)+국외 연구진
- 의약학 > 응용의학
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