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Barbato, E; Toth, GG; Johnson, NP; Pijls, NH; Fearon, WF; Tonino, PA; Curzen, N; Piroth, Z; Rioufol, G; Jüni, P; De Bruyne, B.
A Prospective Natural History Study of Coronary Atherosclerosis Using Fractional Flow Reserve.
J Am Coll Cardiol. 2016; 68(21):2247-2255 Doi: 10.1016/j.jacc.2016.08.055 [OPEN ACCESS]
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Toth-Gayor Gabor

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In patients with coronary artery disease, clinical outcome depends on the extent of reversible myocardial ischemia. Whether the outcome also depends on the severity of the stenosis as determined by fractional flow reserve (FFR) remains unknown. This study sought to investigate the relationship between FFR values and vessel-related clinical outcome. We prospectively studied major adverse cardiovascular events (MACE) at 2 years in 607 patients in whom all stenoses were assessed by FFR and who were treated with medical therapy alone. The relationship between FFR and 2-year MACE was assessed as a continuous function. Logistic and Cox proportional hazards regression models were used to calculate the average decrease in the risk of MACE per 0.05-U increase in FFR. MACE occurred in 272 (26.5%) of 1,029 lesions. Target lesions with diameter stenosis ≥70% were more often present in the MACE group (p < 0.01). Median FFR was significantly lower in the MACE group versus the non-MACE group (0.68 [interquartile range: 0.54 to 0.77] vs. 0.80 [interquartile range: 0.70 to 0.88]; p < 0.01). The cumulative incidence of MACE significantly increased with increasing FFR quartiles. An average decrease in MACE per 0.05-unit increase in FFR was statistically significant even after adjustment for all clinical and angiographic features (odds ratio: 0.81; 95% confidence interval: 0.76 to 0.86]). The strongest increase in MACE occurred for FFR values between 0.80 and 0.60. In multivariable Cox regression analysis, FFR was significantly associated with MACE up to 2 years (hazard ratio: 0.87; 95% confidence interval: 0.83 to 0.91]). In patients with stable coronary disease, stenosis severity as assessed by FFR is a major and independent predictor of lesion-related outcome. (FAME II - Fractional Flow Reserve [FFR] Guided Percutaneous Coronary Intervention [PCI] Plus Optimal Medical Treatment [OMT] Verses OMT; NCT01132495). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Find related publications in this database (using NLM MeSH Indexing)
Atherosclerosis - diagnosis
Atherosclerosis - physiopathology
Atherosclerosis - surgery
Coronary Angiography -
Coronary Artery Disease - diagnosis
Coronary Artery Disease - physiopathology
Coronary Artery Disease - surgery
Coronary Vessels - diagnostic imaging
Coronary Vessels - physiopathology
Coronary Vessels - surgery
Female -
Follow-Up Studies -
Fractional Flow Reserve, Myocardial - physiology
Humans -
Male -
Middle Aged -
Percutaneous Coronary Intervention - methods
Prognosis -
Prospective Studies -
Severity of Illness Index -
Time Factors -

Find related publications in this database (Keywords)
clinical outcome
flow reserve
stable angina
vessel related
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