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Prognostic Value of Prerevascularization Fractional Flow Reserve Mediated by the Postrevascularization Level

IMPORTANCE: The prognostic value of pre–percutaneous coronary intervention (PCI) fractional flow reserve (FFR) may be associated with the post-PCI FFR and their interaction. To correctly interpret the prognostic value of pre-PCI FFR, it is essential to understand to what extent the association of pr...

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Autores principales: Hamaya, Rikuta, Mittleman, Murray A., Hoshino, Masahiro, Kanaji, Yoshihisa, Murai, Tadashi, Lee, Joo Myung, Choi, Ki Hong, Zhang, Jun-Jie, Ye, Fei, Li, Xiaobo, Ge, Zhen, Chen, Shao-Liang, Kakuta, Tsunekazu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527875/
https://www.ncbi.nlm.nih.gov/pubmed/32997128
http://dx.doi.org/10.1001/jamanetworkopen.2020.18162
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author Hamaya, Rikuta
Mittleman, Murray A.
Hoshino, Masahiro
Kanaji, Yoshihisa
Murai, Tadashi
Lee, Joo Myung
Choi, Ki Hong
Zhang, Jun-Jie
Ye, Fei
Li, Xiaobo
Ge, Zhen
Chen, Shao-Liang
Kakuta, Tsunekazu
author_facet Hamaya, Rikuta
Mittleman, Murray A.
Hoshino, Masahiro
Kanaji, Yoshihisa
Murai, Tadashi
Lee, Joo Myung
Choi, Ki Hong
Zhang, Jun-Jie
Ye, Fei
Li, Xiaobo
Ge, Zhen
Chen, Shao-Liang
Kakuta, Tsunekazu
author_sort Hamaya, Rikuta
collection PubMed
description IMPORTANCE: The prognostic value of pre–percutaneous coronary intervention (PCI) fractional flow reserve (FFR) may be associated with the post-PCI FFR and their interaction. To correctly interpret the prognostic value of pre-PCI FFR, it is essential to understand to what extent the association of pre-PCI FFR with clinical outcomes is explained by post-PCI FFR. OBJECTIVE: To investigate the extent to which post-PCI FFR mediates the association of pre-PCI FFR with vessel-related outcomes using an international, multicenter collaboration registry. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used pooled patient data from 4 international FFR registries. A total of 1488 patients with pre-PCI FFR of 0.80 or less who underwent elective PCI were included. Data collection was conducted from November 2011 to August 2019, and analysis was conducted from September 2019 to July 2020. MAIN OUTCOMES AND MEASURES: The primary outcome was target vessel failure (TVF) during 2 years of follow-up. The extent to which post-PCI FFR of less than 0.90 mediated the association of pre-PCI FFR less than 0.75 (vs pre-PCI FFR of 0.75 or greater) with TVF was evaluated using a mediation analysis in a counterfactual framework. RESULTS: Among 1488 patients, the mean (SD) age was 63.5 (9.9) years and 1161 patients (78.0%) were men. The median (interquartile range) pre-PCI and post-PCI FFR were 0.71 (0.62-0.76) and 0.88 (0.83-0.92), respectively. The direct association of low pre-PCI FFR (ie, <0.75) with TVF was significant (odds ratio, 1.81; 95% CI, 1.03-3.17; P = .04), while the mediation by post-PCI FFR level of less than 0.90 was not (indirect association: odds ratio, 1.03; 95% CI, 0.98-1.09; P = .24). In sensitivity analyses using several pre-PCI cutoffs, the mediations by post-PCI FFR were consistently weak. CONCLUSIONS AND RELEVANCE: In this study, the association of pre-PCI FFR with TVF was not significantly mediated by post-PCI FFR. Poor prognosis due to progressed atherosclerosis, represented as low FFR, may not be reversed by successful PCI that increases FFR. Therefore, the prognostic value of pre-PCI FFR may mainly reflect the global atherosclerotic burden, not the extent of the modifiable epicardial stenosis.
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spelling pubmed-75278752020-10-05 Prognostic Value of Prerevascularization Fractional Flow Reserve Mediated by the Postrevascularization Level Hamaya, Rikuta Mittleman, Murray A. Hoshino, Masahiro Kanaji, Yoshihisa Murai, Tadashi Lee, Joo Myung Choi, Ki Hong Zhang, Jun-Jie Ye, Fei Li, Xiaobo Ge, Zhen Chen, Shao-Liang Kakuta, Tsunekazu JAMA Netw Open Original Investigation IMPORTANCE: The prognostic value of pre–percutaneous coronary intervention (PCI) fractional flow reserve (FFR) may be associated with the post-PCI FFR and their interaction. To correctly interpret the prognostic value of pre-PCI FFR, it is essential to understand to what extent the association of pre-PCI FFR with clinical outcomes is explained by post-PCI FFR. OBJECTIVE: To investigate the extent to which post-PCI FFR mediates the association of pre-PCI FFR with vessel-related outcomes using an international, multicenter collaboration registry. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used pooled patient data from 4 international FFR registries. A total of 1488 patients with pre-PCI FFR of 0.80 or less who underwent elective PCI were included. Data collection was conducted from November 2011 to August 2019, and analysis was conducted from September 2019 to July 2020. MAIN OUTCOMES AND MEASURES: The primary outcome was target vessel failure (TVF) during 2 years of follow-up. The extent to which post-PCI FFR of less than 0.90 mediated the association of pre-PCI FFR less than 0.75 (vs pre-PCI FFR of 0.75 or greater) with TVF was evaluated using a mediation analysis in a counterfactual framework. RESULTS: Among 1488 patients, the mean (SD) age was 63.5 (9.9) years and 1161 patients (78.0%) were men. The median (interquartile range) pre-PCI and post-PCI FFR were 0.71 (0.62-0.76) and 0.88 (0.83-0.92), respectively. The direct association of low pre-PCI FFR (ie, <0.75) with TVF was significant (odds ratio, 1.81; 95% CI, 1.03-3.17; P = .04), while the mediation by post-PCI FFR level of less than 0.90 was not (indirect association: odds ratio, 1.03; 95% CI, 0.98-1.09; P = .24). In sensitivity analyses using several pre-PCI cutoffs, the mediations by post-PCI FFR were consistently weak. CONCLUSIONS AND RELEVANCE: In this study, the association of pre-PCI FFR with TVF was not significantly mediated by post-PCI FFR. Poor prognosis due to progressed atherosclerosis, represented as low FFR, may not be reversed by successful PCI that increases FFR. Therefore, the prognostic value of pre-PCI FFR may mainly reflect the global atherosclerotic burden, not the extent of the modifiable epicardial stenosis. American Medical Association 2020-09-30 /pmc/articles/PMC7527875/ /pubmed/32997128 http://dx.doi.org/10.1001/jamanetworkopen.2020.18162 Text en Copyright 2020 Hamaya R et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Hamaya, Rikuta
Mittleman, Murray A.
Hoshino, Masahiro
Kanaji, Yoshihisa
Murai, Tadashi
Lee, Joo Myung
Choi, Ki Hong
Zhang, Jun-Jie
Ye, Fei
Li, Xiaobo
Ge, Zhen
Chen, Shao-Liang
Kakuta, Tsunekazu
Prognostic Value of Prerevascularization Fractional Flow Reserve Mediated by the Postrevascularization Level
title Prognostic Value of Prerevascularization Fractional Flow Reserve Mediated by the Postrevascularization Level
title_full Prognostic Value of Prerevascularization Fractional Flow Reserve Mediated by the Postrevascularization Level
title_fullStr Prognostic Value of Prerevascularization Fractional Flow Reserve Mediated by the Postrevascularization Level
title_full_unstemmed Prognostic Value of Prerevascularization Fractional Flow Reserve Mediated by the Postrevascularization Level
title_short Prognostic Value of Prerevascularization Fractional Flow Reserve Mediated by the Postrevascularization Level
title_sort prognostic value of prerevascularization fractional flow reserve mediated by the postrevascularization level
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527875/
https://www.ncbi.nlm.nih.gov/pubmed/32997128
http://dx.doi.org/10.1001/jamanetworkopen.2020.18162
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