Abstract | BACKGROUND: The resting distal-to-aortic coronary pressure ratio (Pd/Pa) is a universally available, hyperemia-free physiological index of coronary stenosis. We investigated clinical outcomes according to resting Pd/Pa versus hyperemic fractional flow reserve (FFR). METHODS: From the IRIS-FFR (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve) registry, 7014 lesions in 4707 patients with valid resting Pd/Pa and FFR were included in this study. The primary outcome was major adverse cardiac events ( MACE; a composite of cardiac death, myocardial infarction, and repeat intervention). The MACE rate was compared among resting Pd/Pa ≤0.92 and FFR ≤0.80. A marginal Cox model accounted for correlated data in patients with multiple lesions. RESULTS: During a median follow-up of 2.0 years, 223 MACEs occurred. Resting Pd/Pa was an independent predictor for the occurrence of MACE (adjusted hazard ratio [aHR], 1.89 [95% CI, 1.32-2.71]; P=0.001) over clinical and angiographic variables. When resting Pd/Pa and FFR were added into a multivariable model, MACE was no longer significantly associated with resting Pd/Pa (aHR, 1.35 [95% CI, 0.93-1.97]; P=0.12) but remained to be associated with FFR (aHR, 2.34 [95% CI, 1.56-3.54]; P<0.001). Compared with lesions with normal value of resting Pa/Pa and FFR, lesions with abnormal values of either resting Pd/Pa (aHR, 2.12 [95% CI, 1.17-3.84]; P=0.014) or FFR (aHR, 2.32 [95% CI, 1.52-3.55]; P<0.001) or both (aHR, 2.37 [95% CI, 1.57-3.57]; P<0.001) showed a significantly increased risk of the occurrence of MACE. CONCLUSIONS: Resting Pd/Pa appeared to be a less-robust prognostic index than FFR. Resting Pd/Pa could be used as a prognostic index when hyperemic agents are contraindicated or not easily available. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01366404.
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Authors | Jung-Min Ahn, Duk-Woo Park, Seon-Ok Kim, Do-Yoon Kang, Cheol-Hyun Lee, Pil Hyung Lee, Seung-Whan Lee, Seong-Wook Park, Seung-Jung Park |
Journal | Circulation. Cardiovascular interventions
(Circ Cardiovasc Interv)
Vol. 13
Issue 5
Pg. e007868
(05 2020)
ISSN: 1941-7632 [Electronic] United States |
PMID | 32345039
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
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Topics |
- Aged
- Aorta
(physiopathology)
- Arterial Pressure
- Cardiac Catheterization
- Coronary Angiography
- Coronary Stenosis
(diagnosis, mortality, physiopathology, therapy)
- Coronary Vessels
(diagnostic imaging, physiopathology)
- Female
- Fractional Flow Reserve, Myocardial
- Humans
- Hyperemia
(physiopathology)
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Prospective Studies
- Registries
- Reproducibility of Results
- Republic of Korea
- Risk Assessment
- Risk Factors
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