JAMA Netw Open. 2022;5(9):e2232842.
Prognostic Implications of Fractional Flow Reserve After Coronary Stenting: A Systematic Review and Meta-analysis.
제1저자 황도연 · 교신저자 구본권
소속 (26)
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
- Division of Cardiology, Ulsan Hospital, Ulsan, Korea.
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
- University Heart Centre Graz, Medical University Graz, Austria.
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary.
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston.
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
- National Institute of Cardiovascular Diseases, Karachi, Pakistan.
- Central Arkansas VA Health System, Little Rock, Arkansas.
- University of Arkansas for Medical Sciences, Little Rock.
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
- Division of Cardiology, Department of Medicine, University of Washington, Seattle.
- Division of Cardiovascular Diseases, University of Alabama, Birmingham.
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands.
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.
- Cardiovascular Center Aalst, Aalst, Belgium.
- Department of Cardiology, University of Lausanne, Switzerland.
Abstract
IMPORTANCE Fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is generally considered to reflect residual disease. Yet the clinical relevance of post-PCI FFR after drug-eluting stent (DES) implantation remains unclear.
OBJECTIVE To evaluate the clinical relevance of post-PCI FFR measurement after DES implantation.
DATA SOURCES MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant published articles from inception to June 18, 2022.
STUDY SELECTION Published articles that reported post-PCI FFR after DES implantation and its association with clinical outcomes were included.
DATA EXTRACTION AND SYNTHESIS Patient-level data were collected from the corresponding authors of 17 cohorts using a standardized spreadsheet. Meta-estimates for primary and secondary outcomes were analyzed per patient and using mixed-effects Cox proportional hazard regression with registry identifiers included as a random effect. All processes followed the Preferred Reporting Items for Systematic Review and Meta-analysis of Individual Participant Data.
MAIN OUTCOMES AND MEASURES The primary outcome was target vessel failure (TVF) at 2 years, a composite of cardiac death, target vessel myocardial infarction (TVMI), and target vessel revascularization (TVR). The secondary outcome was a composite of cardiac death or TVMI at 2 years.
RESULTS Of 2268 articles identified, 29 studies met selection criteria. Of these, 28 articles from 17 cohorts provided data, including a total of 5277 patients with 5869 vessels who underwent FFR measurement after DES implantation. Mean (SD) age was 64.4 (10.1) years and 4141 patients (78.5%) were men. Median (IQR) post-PCI FFR was 0.89 (0.84-0.94) and 690 vessels (11.8%) had a post-PCI FFR of 0.80 or below. The cumulative incidence of TVF was 340 patients (7.2%), with cardiac death or TVMI occurring in 111 patients (2.4%) at 2 years. Lower post-PCI FFR significantly increased the risk of TVF (adjusted hazard ratio [HR] per 0.01 FFR decrease, 1.04; 95% CI, 1.02-1.05; P < .001). The risk of cardiac death or MI also increased inversely with post-PCI FFR (adjusted HR, 1.03; 95% CI, 1.00-1.07, P = .049). These associations were consistent regardless of age, sex, the presence of hypertension or diabetes, and clinical diagnosis.
CONCLUSIONS AND RELEVANCE Reduced FFR after DES implantation was common and associated with the risks of TVF and of cardiac death or TVMI. These results indicate the prognostic value of post-PCI physiologic assessment after DES implantation.
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그림 출처: PubMed Central 공개 논문 (PMC9500557)
Conflict of interest statement
Conflict of Interest Disclosures: Dr Koo reported receiving grants from Abbott Vascular and Philips Volcano during the conduct of the study. Dr Johnson reported receiving grants from Philips Volcano, St Jude Medical, Abiomed, and CoreAalst during the conduct of the study; he reported receiving licensing fees from Boston Scientific Institutional and the University of Texas outside the submitted work; in addition, Dr Johnson reported multiple patents pending with University of Texas; he reported receiving honoraria for talks hosted by academic institutions and industry outside the submitted work, which he donates to his institution. Dr Pijls reported receiving an institutional research grant from Abbott; he reported holding minor equity in Philips, Heartflow, GE, and ASML and has patents pending in the field of aortic valve physiology and the coronary microcirculation. Dr Tanaka reported receiving personal fees from Abbott Vascular Japan and personal fees from Daiichi-Sankyo Co Ltd during the conduct of the study. Dr Azzalini reported receiving personal fees from Abiomed, GE Healthcare, Abbott Vascular, Teleflex, Philips, Asahi Intecc, and Cardiovascular Systems, Inc outside the submitted work. Dr Neleman reported receiving grants from Acist Medical outside the submitted work. Dr van Mieghem reported receiving grants from Abbott, Boston Scientific, Biotronik, Medtronic, Daiichi Sankyo, Abiomed, and PulseCath BV outside the submitted work. Dr Daemen reported receiving grants from Astra Zeneca, Abbott Vascular, Boston Scientific, ACIST Medical, Medtronic, Microport, Pie Medical, and ReCor Medical and consultancy or speaker fees from Abiomed, ACIST Medical, Boston Scientific, PulseCath, Pie Medical, Siemens Health Care, and Medtronic outside the submitted work. Dr Collison reported receiving personal fees from Abbott outside the submitted work. No other disclosures were reported.
그 밖의 정보
- 출판 형태
- Journal Article, Meta-Analysis, Systematic Review
- 저널
- JAMA network open · eISSN 2574-3805
- 전자 출판
- 2022-09-01
- MeSH
- Coronary Angiography · Death · Drug-Eluting Stents* / adverse effects · Female · Fractional Flow Reserve, Myocardial* / physiology · Humans · Male · Middle Aged · Myocardial Infarction* / etiology · Percutaneous Coronary Intervention* / adverse effects · Prognosis · Treatment Outcome
- 참고문헌
- 73편