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Published on: June 28, 2019
Thrombotic Risk and Cardiovascular Events in Patients With Revascularization Deferral After Fractional Flow
Yasutsugu Shiono1, Shoichi Kuramitsu2, Hitoshi Matsuo3
1Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Insights
Assessing thrombotic risk alongside fractional flow reserve (FFR) improves prediction of cardiovascular events in patients with deferred revascularization. High thrombotic risk significantly increases the likelihood of target vessel failure and major adverse cardiac events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Fractional flow reserve (FFR) guided deferral of revascularization is common practice.
- Despite FFR guidance, some patients experience cardiovascular events post-deferral.
- Thrombotic risk factors may influence outcomes in these patients.
Purpose of the Study:
- To evaluate the impact of thrombotic risk on cardiovascular events in patients with coronary artery disease.
- To assess the prognostic value of thrombotic risk in addition to FFR for deferred revascularization.
- To investigate the association between CREDO-Kyoto thrombotic score and 5-year outcomes.
Main Methods:
- Analysis of 1,263 patients from the J-CONFIRM registry with deferred revascularization based on FFR.
- Assessment of thrombotic risk using the CREDO-Kyoto thrombotic score.
- Investigation of the association between thrombotic risk, FFR, and 5-year target vessel failure (TVF) and major adverse cardiac and cerebrovascular events (MACCE).
Main Results:
- Both lower FFR values and high thrombotic risk (HTR) were independently associated with increased 5-year TVF and MACCE.
- Patients with HTR exhibited a significantly higher risk of TVF and MACCE compared to those without HTR, irrespective of FFR results.
- FFR (per 0.01-unit decrease): HR 1.08 for TVF, HR 1.05 for MACCE. HTR: HR 2.16 for TVF, HR 2.11 for MACCE.
Conclusions:
- Thrombotic risk assessment provides crucial prognostic information beyond FFR in patients with deferred revascularization.
- Identifying high thrombotic risk patients is essential for risk stratification and management.
- This approach enhances prediction of long-term adverse cardiovascular outcomes.
Objectives:
The aim of this study was to evaluate the impact of thrombotic risk on the occurrence of cardiovascular events in patients with coronary artery disease with deferred revascularization after fractional flow reserve (FFR) measurements.
Background:
Deferral of revascularization on the basis of FFR is generally considered to be safe, but after deferral, some patients have cardiovascular events over time.
Methods:
From J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), 1,263 patients with deferral of revascularization on the basis of FFR were evaluated. The association between thrombotic risk as assessed by CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) thrombotic score and 5-year target vessel failure (TVF) and major adverse cardiac and cerebrovascular events (MACCE) was investigated.
Results:
FFR and high thrombotic risk (HTR) were associated with increased risk for 5-year TVF (FFR per 0.01-unit decrease: HR: 1.08; 95% CI: 1.05-1.11; P < 0.001; HTR: HR: 2.16; 95% CI: 1.37-3.39; P < 0.001) and MACCE (FFR per 0.01-unit decrease: HR: 1.05; 95% CI: 1.02-1.06; P < 0.001; HTR: HR: 2.11; 95% CI: 1.56-2.84; P = 0.001). Patients with HTR had higher risk for 5-year TVF (HR: 2.30; 95% CI: 1.45-3.66; P < 0.001) and MACCE (HR: 2.34; 95% CI: 1.75-3.13; P < 0.001) than those without HTR, even when they had negative FFR.
Conclusions:
Assessment of thrombotic risk provides additional prognostic value to FFR in predicting 5-year TVF and MACCE in patients with deferral of revascularization after FFR measurements. (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry; UMIN000014473).
