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Long-Term Clinical Outcomes of Fractional Flow Reserve-Guided Coronary Artery Revascularization in Chronic Kidney

Chien-Boon Jong1,2, Tsui-Shan Lu3, Patrick Yan-Tyng Liu4,5

  • 1Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu 300195, Taiwan.

Journal of Personalized Medicine
|January 21, 2022
PubMed

Insights

Fractional flow reserve (FFR)-guided procedures in chronic kidney disease (CKD) patients showed increased risks for cardiac events and target vessel failure. Revascularization did not improve outcomes in this vulnerable population.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) offers favorable long-term outcomes.
  • Data on FFR assessment in chronic kidney disease (CKD) patients are limited.
  • CKD is associated with increased cardiovascular risk and potentially different responses to revascularization.

Purpose of the Study:

  • To evaluate the long-term clinical outcomes of FFR-guided coronary revascularization in patients with CKD.
  • To determine if FFR-guided revascularization improves outcomes in CKD patients compared to non-revascularization.
  • To assess the safety and efficacy of FFR-guided PCI in a CKD population.

Main Methods:

  • Retrospective analysis of 242 CKD patients who underwent FFR assessment.
  • Division into two groups: revascularization (FFR ≤ 0.80) and non-revascularization (FFR > 0.80).
  • Primary endpoint: composite of cardiac death, non-fatal myocardial infarction, and target vessel failure (TVF). Secondary endpoint: TVF. Cox regression analysis used for risk evaluation.

Main Results:

  • The revascularization group (91% ischemic vessels treated) showed higher risks for the primary endpoint (aHR: 2.06; 95% CI: 1.07-3.97; p=0.030).
  • The revascularization group also had higher risks for TVF (aHR: 2.19; 95% CI: 1.10-4.37; p=0.026) during a median 2.9-year follow-up.
  • Results were consistent across different CKD severities.

Conclusions:

  • In CKD patients, functional ischemia in coronary artery stenosis is linked to poor clinical outcomes, even after coronary revascularization.
  • FFR-guided revascularization did not demonstrate improved long-term clinical outcomes in this CKD population.
  • Further research is needed to optimize revascularization strategies for CKD patients with coronary artery disease.

Keywords:
chronic kidney diseaseclinical outcomefractional flow reserverevascularization

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