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SHR Neuro Cancer Cardio Lipid Metab Microb

Collet, C; Johnson, NP; Mizukami, T; Fearon, WF; Berry, C; Sonck, J; Collison, D; Koo, BK; Meneveau, N; Agarwal, SK; Uretsky, B; Hakeem, A; Doh, JH; Da, Costa, BR; Oldroyd, KG; Leipsic, JA; Morbiducci, U; Taylor, C; Ko, B; Tonino, PAL; Perera, D; Shinke, T; Chiastra, C; Sposito, AC; Leone, AM; Muller, O; Fournier, S; Matsuo, H; Adjedj, J; Amabile, N; Piróth, Z; Alfonso, F; Rivero, F; Ahn, JM; Toth, GG; Ihdayhid, A; West, NEJ; Amano, T; Wyffels, E; Munhoz, D; Belmonte, M; Ohashi, H; Sakai, K; Gallinoro, E; Barbato, E; Engstrøm, T; Escaned, J; Ali, ZA; Kern, MJ; Pijls, NHJ; Jüni, P; De, Bruyne, B.
Impact of Post-PCI FFR Stratified by Coronary Artery.
JACC Cardiovasc Interv. 2023; 16(19):2396-2408 Doi: 10.1016/j.jcin.2023.08.018
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Co-authors Med Uni Graz
Toth-Gayor Gabor
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Abstract:
BACKGROUND: Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated. OBJECTIVES: This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery. METHODS: We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization. RESULTS: Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005). CONCLUSIONS: The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.
Find related publications in this database (using NLM MeSH Indexing)
Humans - administration & dosage
Coronary Artery Disease - diagnostic imaging, therapy
Percutaneous Coronary Intervention - adverse effects
Fractional Flow Reserve, Myocardial - administration & dosage
Coronary Angiography - administration & dosage
Treatment Outcome - administration & dosage
Predictive Value of Tests - administration & dosage

Find related publications in this database (Keywords)
coronary artery disease
diffuse disease
percutaneous coronary intervention
post-PCI fractional flow reserve
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