한빛사 논문
Juwon Kim MDa,∗, Doosup Shin MDb,∗, Joo Myung Lee MD, MPH, PhDa,#, Seung Hun Lee MD, PhDc, David Hong MDa, Ki Hong Choi MD, PhDa, Doyeon Hwang MDd, Coen K.M. Boerhout MDe, Guus A. de Waard MD, PhDf, Ji-Hyun Jung MDg, Hernan Mejia-Renteria MD, PhDh, Masahiro Hoshino MDi, Mauro Echavarria-Pinto MD, PhDj, Martijn Meuwissen MD, PhDk, Hitoshi Matsuo MD, PhDl, Maribel Madera-Cambero MDm, Ashkan Eftekhari MD, PhDn, Mohamed A. Effat MDo, Tadashi Murai MDi, Koen Marques MD, PhDf, Joon-Hyung Doh MD, PhDp, Evald H. Christiansen MD, PhDn, Rupak Banerjee PhDq, Hyun Kuk Kim MD, PhDr, Chang-Wook Nam MD, PhDs, Giampaolo Niccoli MD, PhDt, Masafumi Nakayama MD, PhDl,u, Nobuhiro Tanaka MD, PhDv, Eun-Seok Shin MD, PhDw, Steven A.J. Chamuleau MD, PhDe,f, Nielsvan Royen MD, PhDx, Paul Knaapen MD, PhDf, Bon Kwon Koo MD, PhDd, Tsunekazu Kakuta MD, PhDi, Javier Escaned MD, PhDh, Jan J. Piek MD, PhDe, Tim P. van de Hoef MD, PhDe,f,y, on behalf of the ILIAS Registry Investigators
aDivision of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
bDivision of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
cDivision of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
dSeoul National University Hospital, Department of Internal Medicine, Cardiovascular Center, Seoul, Korea
eDepartment of Cardiology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, the Netherlands
fDepartment of Cardiology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
gSejong General Hospital, Sejong Heart Institute, Bucheon, Korea
hHospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
iDepartment of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura City, Japan
jHospital General Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estad Querétaro, Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
kDepartment of Cardiology, Amphia Hospital, Breda, the Netherlands
lDepartment of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
mDepartment of Cardiology, Tergooi Hospital, Blaricum, the Netherlands
nDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark
oDivision of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
pDepartment of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
qDepartment of Mechanical and Materials Engineering, University of Cincinnati, Veterans Affairs Medical Center, Cincinnati, Ohio, USA
rDepartment of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
sDepartment of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
tUniversity of Parma, Parma, Italy
uToda Central General Hospital, Cardiovascular Center, Toda, Japan
vDepartment of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
wDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
xDepartment of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
yDepartment of Cardiology, NoordWest Ziekenhuisgroep, the Netherlands
∗Drs Kim and Shin contributed equally to this work.
#Corresponding author.
Abstract
Objectives
The authors sought to evaluate comparative prognosis between deferred versus performed percutaneous coronary intervention (PCI) according to coronary flow reserve (CFR) values of patients with intermediate fractional flow reserve (FFR).
Background
For coronary stenosis with intermediate FFR, the prognostic value of PCI remains controversial. The prognostic impact of PCI may be different according to CFR in patients with intermediate FFR.
Methods
From the ILIAS Registry (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry, N = 2,322), 400 patients (412 vessels) with intermediate FFR (0.75-0.80) were selected. Patients were stratified into preserved CFR (>2.0, n = 253) and depressed CFR (≤2.0, n = 147) cohorts. Per-vessel clinical outcomes during 5 years of follow-up were compared between deferred versus performed PCI groups in both cohorts. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization.
Results
Among the study population, PCI was deferred for 210 patients (219 vessels, 53.2%) (deferred group) and performed for 190 patients (193 vessels, 46.8%) (performed group). The risk of TVF was comparable between the deferred and performed groups (12.8% vs 14.2%; adjusted HR: 1.403; 95% CI: 0.584-3.369; P = 0.448). When stratified by CFR, PCI was performed in 39.1% (100/261 vessels) of the preserved CFR cohort and 61.9% (93/151 vessels) of the depressed CFR cohort. Within the preserved CFR cohort, the risk of TVF did not differ significantly between the deferred and performed groups (11.0% vs 13.9%; adjusted HR: 0.770; 95% CI: 0.262-2.266; P = 0.635). However, in the depressed CFR cohort, the deferred group had a significantly higher risk of TVF than the performed group (17.2% vs 14.2%; adjusted HR: 4.932; 95% CI: 1.312-18.53; P = 0.018). A significant interaction was observed between CFR and the treatment decision (interaction P = 0.049). Results were consistent after inverse probability weighting adjustment.
Conclusions
In patients with intermediate FFR of 0.75 to 0.80, the prognostic value of PCI differed according to CFR, with a significant interaction. PCI was associated with a lower risk of TVF compared with the deferral strategy when CFR was depressed (≤2.0), but there was no difference when CFR was preserved (>2.0). CFR could be used as an additional risk stratification tool to determine treatment strategies in patients with intermediate FFR. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry]; NCT04485234)
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