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Influence of Anatomical and Clinical Characteristics on Long-Term Prognosis of FFR-Guided Deferred Coronary Lesions
Yun-Kyeong Cho1, Jongmin Hwang1, Cheol Hyun Lee1
1Department of Cariology, Keimyung University Dongsan Hospital, Daegu, Korea.
Insights
Fractional flow reserve (FFR)-guided deferred lesions show excellent 5-year outcomes. Clinical and anatomical factors from intravascular ultrasound (IVUS) predict future risks in these patients.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Medical imaging
Background:
- Fractional flow reserve (FFR)-guided deferral of intermediate coronary lesions is associated with low short-term adverse events.
- However, the combined predictive value of clinical and anatomical factors for long-term outcomes after deferral is not well-established.
Purpose of the Study:
- To evaluate clinical and anatomical predictors of 5-year patient-oriented composite outcomes (POCO) in patients with FFR-guided deferred lesions.
- To assess the incremental prognostic information provided by intravascular ultrasound (IVUS) imaging alongside clinical data.
Main Methods:
- A prospective study included 459 patients with 552 intermediate lesions deferred based on non-ischemic FFR (>0.80).
- Grayscale intravascular ultrasound (IVUS) imaging was performed simultaneously with FFR assessment.
- The primary endpoint was the 5-year patient-oriented composite outcome (POCO), including all-cause death, myocardial infarction, and any revascularization.
Main Results:
- The 5-year POCO rate was 9.8%.
- Independent predictors for POCO included diabetes mellitus (HR: 3.50), left ventricular ejection fraction ≤40% (HR: 4.80), and positive arterial remodeling (HR: 2.04).
- Risk incrementally increased with adverse clinical and plaque characteristics, reaching 21.3% in patients with both (p < 0.001).
Conclusions:
- Patients with FFR-guided deferred lesions experience excellent 5-year clinical outcomes.
- Both patient-related clinical factors and lesion-related anatomical factors from IVUS provide incremental information for predicting future clinical risk.
- Combined assessment of clinical and anatomical features can refine risk stratification in this patient cohort.
Objectives:
The aim of this study was to evaluate the clinical and anatomical features to predict the long-term outcomes in patients with fractional flow reserve (FFR)-guided deferred lesions, verified by intravascular ultrasound (IVUS).
Background:
Deferral of nonsignificant lesion by FFR is associated with a low risk of clinical events. However, the impact of combined information on clinical and anatomical factors is not well known.
Methods:
The study included 459 patients with 552 intermediate lesions who had deferred revascularization on the basis of a nonischemic FFR (>0.80). Grayscale IVUS was examined simultaneously. The primary endpoint was patient-oriented composite outcome (POCO) (a composite of all-cause death, myocardial infarction, and any revascularization) during 5-year follow-up.
Results:
The rate of 5-year POCO was 9.8%. Diabetes mellitus (hazard ratio: 3.50; 95% confidence interval [CI]: 1.86 to 6.57; p < 0.001), left ventricular ejection fraction ≤40% (hazard ratio: 4.80; 95% CI: 1.57 to 14.63; p = 0.006), and positive remodeling (hazard ratio: 2.04; 95% CI: 1.03 to 4.03; p = 0.041) were independent predictors for POCO. When the lesions were classified according to the presence of the adverse clinical characteristics (diabetes, left ventricular ejection fraction ≤40%) or adverse plaque characteristics (positive remodeling, plaque burden ≥70%), the risk of POCO was incrementally increased (4.3%, 13.6%, and 21.3%, respectively; p < 0.001).
Conclusions:
In patients with FFR-guided deferred lesions, 5-year clinical outcomes were excellent. Lesion-related anatomical factors from intravascular imaging as well as patient-related clinical factors could provide incremental information about future clinical risks.
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