JACC Cardiovasc Interv. 2018;11(3):237-245.
Prognostic Implication of Functional Incomplete Revascularization and Residual Functional SYNTAX Score in Patients With Coronary Artery Disease.
제1저자 최기홍 · 교신저자 구본권
소속 (15)
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea.
- Department of Internal Medicine and Cardiovascular Center; Seoul National University, Seoul, Korea; Institute on Aging, Seoul National University, Seoul, Korea. Electronic address: bkkoo@snu.ac.kr.
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea.
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
- Department of Internal Medicine and Cardiovascular Center; Seoul National University, Seoul, Korea.
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
- Kokura Memorial Hospital, Kitakyuku, Japan.
- Department of Cardiology, Gifu Heart Center, Gifu, Japan.
- Department of Cardiology, Aichi Medical University, Nagakute, Japan.
- Wakayama Medical University, Wakayama, Japan.
Abstract
OBJECTIVES The aim of this study was to investigate the prognostic implication of functional incomplete revascularization (IR) and residual functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (rFSS) in comparison with 3-vessel fractional flow reserve (FFR) and residual SYNTAX score.
BACKGROUND IR is associated with poor clinical outcomes in patients who underwent percutaneous coronary intervention.
METHODS A total of 385 patients who underwent 3-vessel FFR measurement after stent implantation were included in this study. The rFSS was defined as residual SYNTAX score measured only in vessels with FFR ≤0.8. The study population was divided into the functional IR group (rFSS ≥1) and the functional complete revascularization (CR) group (rFSS = 0). The primary outcome was major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization) at 2 years.
RESULTS Functional CR was achieved in 283 patients (73.5%). At 2-year follow-up, the functional IR group showed a significantly higher risk for MACEs (functional IR vs. CR, 14.6% vs. 4.2%; hazard ratio: 4.09; 95% confidence interval: 1.82 to 9.21; p < 0.001) than the functional CR group. In a multivariate-adjusted model, functional IR was an independent predictor of MACEs (adjusted hazard ratio: 4.17; 95% confidence interval: 1.85 to 9.44; p < 0.001). The rFSS showed a significant association with estimated 2-year MACE rate (hazard ratio: 1.09 per 1-U increase; 95% confidence interval: 1.02 to 1.17; p = 0.018). When added to clinical risk factors, rFSS showed the highest integrated discrimination improvement value for MACEs (3.5%; p = 0.002) among 3-vessel FFR, residual SYNTAX score, and rFSS.
CONCLUSIONS Patients with functional IR showed significantly higher rate of 2-year MACEs than those with functional CR. A combined anatomic and physiological scoring system (rFSS) after stent implantation better discriminated the risk for adverse events than anatomic or physiological assessment alone. (Clinical Implication of 3-Vessel Fractional Flow Reserve [FFR]; NCT01621438).
Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Keywords
SYNTAX scorecoronary artery diseasefractional flow reservefunctional SYNTAX scorepercutaneous coronary intervention
Comment · 정정
그 밖의 정보
- 출판 형태
- Comparative Study, Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't
- 저널
- JACC. Cardiovascular interventions · eISSN 1876-7605
- 전자 출판
- 2018-01-17
- MeSH
- Aged · Cardiac Catheterization · Coronary Angiography* · Coronary Artery Disease / diagnostic imaging / mortality / physiopathology / surgery · Coronary Stenosis / diagnostic imaging / mortality / physiopathology / surgery · Female · Fractional Flow Reserve, Myocardial · Humans · Japan · Male · Middle Aged · Percutaneous Coronary Intervention / adverse effects / instrumentation / mortality · Postoperative Complications / diagnostic imaging / etiology / mortality / physiopathology · Predictive Value of Tests · Prospective Studies · Recovery of Function · Republic of Korea · Risk Assessment · Risk Factors · Stents · Time Factors · Treatment Outcome
- 데이터
- ClinicalTrials.gov: NCT01621438