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Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long‐Term Survival
BACKGROUND: Deferring revascularization in patients with nonsignificant stenoses based on fractional flow reserve (FFR) is associated with favorable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction is unclear. We aimed to investiga...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9673723/ https://www.ncbi.nlm.nih.gov/pubmed/36129045 http://dx.doi.org/10.1161/JAHA.122.026656 |
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author | Gallinoro, Emanuele Paolisso, Pasquale Di Gioia, Giuseppe Bermpeis, Kostantinos Fernandez‐Peregrina, Estefania Candreva, Alessandro Esposito, Giuseppe Fabbricatore, Davide Bertolone, Dario Tino Bartunek, Jozef Vanderheyden, Marc Wyffels, Eric Sonck, Jeroen Collet, Carlos De Bruyne, Bernard Barbato, Emanuele |
author_facet | Gallinoro, Emanuele Paolisso, Pasquale Di Gioia, Giuseppe Bermpeis, Kostantinos Fernandez‐Peregrina, Estefania Candreva, Alessandro Esposito, Giuseppe Fabbricatore, Davide Bertolone, Dario Tino Bartunek, Jozef Vanderheyden, Marc Wyffels, Eric Sonck, Jeroen Collet, Carlos De Bruyne, Bernard Barbato, Emanuele |
author_sort | Gallinoro, Emanuele |
collection | PubMed |
description | BACKGROUND: Deferring revascularization in patients with nonsignificant stenoses based on fractional flow reserve (FFR) is associated with favorable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction is unclear. We aimed to investigate whether FFR provides adjunctive clinical benefit compared with coronary angiography in deferring revascularization of patients with intermediate coronary stenoses and reduced left ventricular ejection fraction. METHODS AND RESULTS: Consecutive patients with reduced left ventricular ejection fraction (≤50%) undergoing coronary angiography between 2002 and 2010 were screened. We included patients with at least 1 intermediate coronary stenosis (diameter stenosis ≥40%) in whom revascularization was deferred based either on angiography plus FFR (FFR guided) or angiography alone (angiography guided). The primary end point was the cumulative incidence of all‐cause death at 10 years. The secondary end point (incidence of major adverse cardiovascular and cerebrovascular events) was a composite of all‐cause death, myocardial infarction, any revascularization, and stroke. A total of 840 patients were included (206 in the FFR‐guided group and 634 in the angiography‐guided group). Median follow‐up was 7 years (interquartile range, 3.22–11.08 years). After 1:1 propensity‐score matching, baseline characteristics between the 2 groups were similar. All‐cause death was significantly lower in the FFR‐guided group compared with the angiography‐guided group (94 [45.6%] versus 119 [57.8%]; hazard ratio [HR], 0.65 [95% CI, 0.49–0.85]; P<0.01). The rate of major adverse cardiovascular and cerebrovascular events was lower in the FFR‐guided group (123 [59.7%] versus 139 [67.5%]; HR, 0.75 [95% CI, 0.59–0.95]; P=0.02). CONCLUSIONS: In patients with reduced left ventricular ejection fraction, deferring revascularization of intermediate coronary stenoses based on FFR is associated with a lower incidence of death and major adverse cardiovascular and cerebrovascular events at 10 years. |
format | Online Article Text |
id | pubmed-9673723 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-96737232022-11-21 Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long‐Term Survival Gallinoro, Emanuele Paolisso, Pasquale Di Gioia, Giuseppe Bermpeis, Kostantinos Fernandez‐Peregrina, Estefania Candreva, Alessandro Esposito, Giuseppe Fabbricatore, Davide Bertolone, Dario Tino Bartunek, Jozef Vanderheyden, Marc Wyffels, Eric Sonck, Jeroen Collet, Carlos De Bruyne, Bernard Barbato, Emanuele J Am Heart Assoc Original Research BACKGROUND: Deferring revascularization in patients with nonsignificant stenoses based on fractional flow reserve (FFR) is associated with favorable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction is unclear. We aimed to investigate whether FFR provides adjunctive clinical benefit compared with coronary angiography in deferring revascularization of patients with intermediate coronary stenoses and reduced left ventricular ejection fraction. METHODS AND RESULTS: Consecutive patients with reduced left ventricular ejection fraction (≤50%) undergoing coronary angiography between 2002 and 2010 were screened. We included patients with at least 1 intermediate coronary stenosis (diameter stenosis ≥40%) in whom revascularization was deferred based either on angiography plus FFR (FFR guided) or angiography alone (angiography guided). The primary end point was the cumulative incidence of all‐cause death at 10 years. The secondary end point (incidence of major adverse cardiovascular and cerebrovascular events) was a composite of all‐cause death, myocardial infarction, any revascularization, and stroke. A total of 840 patients were included (206 in the FFR‐guided group and 634 in the angiography‐guided group). Median follow‐up was 7 years (interquartile range, 3.22–11.08 years). After 1:1 propensity‐score matching, baseline characteristics between the 2 groups were similar. All‐cause death was significantly lower in the FFR‐guided group compared with the angiography‐guided group (94 [45.6%] versus 119 [57.8%]; hazard ratio [HR], 0.65 [95% CI, 0.49–0.85]; P<0.01). The rate of major adverse cardiovascular and cerebrovascular events was lower in the FFR‐guided group (123 [59.7%] versus 139 [67.5%]; HR, 0.75 [95% CI, 0.59–0.95]; P=0.02). CONCLUSIONS: In patients with reduced left ventricular ejection fraction, deferring revascularization of intermediate coronary stenoses based on FFR is associated with a lower incidence of death and major adverse cardiovascular and cerebrovascular events at 10 years. John Wiley and Sons Inc. 2022-09-21 /pmc/articles/PMC9673723/ /pubmed/36129045 http://dx.doi.org/10.1161/JAHA.122.026656 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Gallinoro, Emanuele Paolisso, Pasquale Di Gioia, Giuseppe Bermpeis, Kostantinos Fernandez‐Peregrina, Estefania Candreva, Alessandro Esposito, Giuseppe Fabbricatore, Davide Bertolone, Dario Tino Bartunek, Jozef Vanderheyden, Marc Wyffels, Eric Sonck, Jeroen Collet, Carlos De Bruyne, Bernard Barbato, Emanuele Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long‐Term Survival |
title | Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long‐Term Survival |
title_full | Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long‐Term Survival |
title_fullStr | Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long‐Term Survival |
title_full_unstemmed | Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long‐Term Survival |
title_short | Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long‐Term Survival |
title_sort | deferral of coronary revascularization in patients with reduced ejection fraction based on physiological assessment: impact on long‐term survival |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9673723/ https://www.ncbi.nlm.nih.gov/pubmed/36129045 http://dx.doi.org/10.1161/JAHA.122.026656 |
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