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Published on: January 28, 2020
Prognostic Impact of Renal Function on Outcomes After Physiology-Guided Coronary Revascularization: Insights From the
Hirofumi Ohashi1, Shoichi Kuramitsu2, Hirohiko Ando1
1Department of Cardiology, Aichi Medical University, Japan (H. Ohashi, H.A., T. Amano).
Background:
The clinical utility of physiology-guided revascularization for decision-making in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) remains uncertain. The aim of this study is to evaluate the diagnostic performance and prognostic significance of fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs) according to the severity of CKD.
Methods:
This subanalysis of the J-PRIDE registry, a prospective multicenter study conducted at 20 Japanese centers between September 2019 and February 2021, included 4296 lesions from 3194 patients who underwent both FFR and NHPR assessment. Patients were categorized by estimated glomerular filtration rate into non-CKD (≥60 mL/min per 1.73 m2; n=1639), CKD (15-59; n=1321), and ESRD (<15 or on dialysis; n=234). The primary end point was 1-year target vessel failure, defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization.
Results:
The 1-year incidence of target vessel failure was significantly higher in the ESRD group than in CKD and non-CKD groups (8.4% versus 2.4% and 2.6%; for CKD, adjusted hazard ratio, 3.09 [95% CI, 1.60-5.96]; P<0.001; for non-CKD, adjusted hazard ratio, 2.88 [95% CI, 1.98-5.47]; P=0.001). The NHPR cutoff predicting FFR ≤0.80 was lower in ESRD compared with CKD and non-CKD (0.85 versus 0.89 versus 0.89). Although the overall prevalence of FFR/NHPR discordance was comparable (23.6%, 19.7%, and 19.7%; P=0.24), FFR-/NHPR+ discordance predominated in ESRD (18.6% versus 9.3% versus 7.0%; P<0.001). FFR-/NHPR+ lesions in the ESRD group exhibited an excess risk compared with other lesions. Revascularization was beneficial in non-CKD patients with FFR+/NHPR- lesions, whereas no clear benefit was observed in patients with CKD and ESRD.
Conclusions:
Patients with ESRD exhibited distinct physiological characteristics and substantially worse outcomes, highlighting the need for tailored coronary revascularization strategies in this population.
Registration:
URL: https://www.umin.ac.jp/ctr; Unique identifier: UMIN000038403.
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