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Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation
Objectives: We investigated the influence of coronary disease characteristics on prognostic implications of residual ischemia after coronary stent implantation. Methods: This study included 1,476 patients with drug-eluting stent implantation and available pre- and post-percutaneous coronary interven...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8688402/ https://www.ncbi.nlm.nih.gov/pubmed/34950710 http://dx.doi.org/10.3389/fcvm.2021.696756 |
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author | Yang, Seokhun Zhang, Jinlong Hwang, Doyeon Lee, Joo Myung Nam, Chang-Wook Shin, Eun-Seok Doh, Joon-Hyung Hoshino, Masahiro Hamaya, Rikuta Kanaji, Yoshihisa Murai, Tadashi Zhang, Jun-Jie Ye, Fei Li, Xiaobo Ge, Zhen Chen, Shao-Liang Kakuta, Tsunekazu Koo, Bon-Kwon |
author_facet | Yang, Seokhun Zhang, Jinlong Hwang, Doyeon Lee, Joo Myung Nam, Chang-Wook Shin, Eun-Seok Doh, Joon-Hyung Hoshino, Masahiro Hamaya, Rikuta Kanaji, Yoshihisa Murai, Tadashi Zhang, Jun-Jie Ye, Fei Li, Xiaobo Ge, Zhen Chen, Shao-Liang Kakuta, Tsunekazu Koo, Bon-Kwon |
author_sort | Yang, Seokhun |
collection | PubMed |
description | Objectives: We investigated the influence of coronary disease characteristics on prognostic implications of residual ischemia after coronary stent implantation. Methods: This study included 1,476 patients with drug-eluting stent implantation and available pre- and post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) measurements. Residual ischemia was defined as post-PCI FFR ≤ 0.80. Coronary disease characteristics with significant interaction hazard ratios (HRs) for clinical outcomes with residual ischemia were defined as interaction characteristics with residual ischemia (ICwRI). The primary outcome was target vessel failure (TVF)—a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization—at 2 years. Results: The mean pre- and post-PCI FFR were 0.68 ± 0.11 and 0.87 ± 0.07, respectively. During the median follow-up duration of 2.0 years, the cumulative incidence of TVF was 6.1%. The 203 vessels (13.8%) with residual ischemia had higher risks of TVF compared to that for post-PCI FFR >0.80 (P < 0.001). ICwRI with a significant interaction HR with residual ischemia included pre-PCI SYNTAX score >17 and pre-PCI FFR ≤ 0.62. Each ICwRI had a direct prognostic effect not mediated by residual ischemia. The association between an increased TVF risk and residual ischemia was significant in patients with 0 or 1 ICwRI [hazard ratio (HR) 3.25, 95% confidence interval (CI) 1.90–5.57, P < 0.001] but not in those with 2 ICwRI (HR 0.47, 95% CI 0.14–1.64, P = 0.24). Among patients with post-PCI FFR >0.80, those with 2 ICwRI showed similar TVF risks to those with residual ischemia (HR 1.55, 95% CI 0.79–3.02, P = 0.20). Conclusions: Coronary disease characteristics including pre-PCI SYNTAX score and pre-PCI FFR affected the prognostic implications of residual ischemia. The prognostic relevance of residual ischemia was attenuated in patients with multiple interacting characteristics. |
format | Online Article Text |
id | pubmed-8688402 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-86884022021-12-22 Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation Yang, Seokhun Zhang, Jinlong Hwang, Doyeon Lee, Joo Myung Nam, Chang-Wook Shin, Eun-Seok Doh, Joon-Hyung Hoshino, Masahiro Hamaya, Rikuta Kanaji, Yoshihisa Murai, Tadashi Zhang, Jun-Jie Ye, Fei Li, Xiaobo Ge, Zhen Chen, Shao-Liang Kakuta, Tsunekazu Koo, Bon-Kwon Front Cardiovasc Med Cardiovascular Medicine Objectives: We investigated the influence of coronary disease characteristics on prognostic implications of residual ischemia after coronary stent implantation. Methods: This study included 1,476 patients with drug-eluting stent implantation and available pre- and post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) measurements. Residual ischemia was defined as post-PCI FFR ≤ 0.80. Coronary disease characteristics with significant interaction hazard ratios (HRs) for clinical outcomes with residual ischemia were defined as interaction characteristics with residual ischemia (ICwRI). The primary outcome was target vessel failure (TVF)—a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization—at 2 years. Results: The mean pre- and post-PCI FFR were 0.68 ± 0.11 and 0.87 ± 0.07, respectively. During the median follow-up duration of 2.0 years, the cumulative incidence of TVF was 6.1%. The 203 vessels (13.8%) with residual ischemia had higher risks of TVF compared to that for post-PCI FFR >0.80 (P < 0.001). ICwRI with a significant interaction HR with residual ischemia included pre-PCI SYNTAX score >17 and pre-PCI FFR ≤ 0.62. Each ICwRI had a direct prognostic effect not mediated by residual ischemia. The association between an increased TVF risk and residual ischemia was significant in patients with 0 or 1 ICwRI [hazard ratio (HR) 3.25, 95% confidence interval (CI) 1.90–5.57, P < 0.001] but not in those with 2 ICwRI (HR 0.47, 95% CI 0.14–1.64, P = 0.24). Among patients with post-PCI FFR >0.80, those with 2 ICwRI showed similar TVF risks to those with residual ischemia (HR 1.55, 95% CI 0.79–3.02, P = 0.20). Conclusions: Coronary disease characteristics including pre-PCI SYNTAX score and pre-PCI FFR affected the prognostic implications of residual ischemia. The prognostic relevance of residual ischemia was attenuated in patients with multiple interacting characteristics. Frontiers Media S.A. 2021-12-07 /pmc/articles/PMC8688402/ /pubmed/34950710 http://dx.doi.org/10.3389/fcvm.2021.696756 Text en Copyright © 2021 Yang, Zhang, Hwang, Lee, Nam, Shin, Doh, Hoshino, Hamaya, Kanaji, Murai, Zhang, Ye, Li, Ge, Chen, Kakuta and Koo. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Yang, Seokhun Zhang, Jinlong Hwang, Doyeon Lee, Joo Myung Nam, Chang-Wook Shin, Eun-Seok Doh, Joon-Hyung Hoshino, Masahiro Hamaya, Rikuta Kanaji, Yoshihisa Murai, Tadashi Zhang, Jun-Jie Ye, Fei Li, Xiaobo Ge, Zhen Chen, Shao-Liang Kakuta, Tsunekazu Koo, Bon-Kwon Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation |
title | Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation |
title_full | Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation |
title_fullStr | Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation |
title_full_unstemmed | Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation |
title_short | Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation |
title_sort | effect of coronary disease characteristics on prognostic relevance of residual ischemia after stent implantation |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8688402/ https://www.ncbi.nlm.nih.gov/pubmed/34950710 http://dx.doi.org/10.3389/fcvm.2021.696756 |
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