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Fractional Flow Reserve and Cardiac Events in Coronary Artery Disease: Data From a Prospective IRIS-FFR Registry (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve).
Ahn, Jung-Min; Park, Duk-Woo; Shin, Eun-Seok; Koo, Bon-Kwon; Nam, Chang-Wook; Doh, Joon-Hyung; Kim, Jun Hong; Chae, In-Ho; Yoon, Jung-Han; Her, Sung-Ho; Seung, Ki-Bae; Chung, Woo-Young; Yoo, Sang-Yong; Lee, Jin Bae; Choi, Si Wan; Park, Kyungil; Hong, Taek Jong; Lee, Sang Yeub; Han, Minkyu; Lee, Pil Hyung; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Lee, Cheol Whan; Park, Seong-Wook; Park, Seung-Jung.
Affiliation
  • Ahn JM; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Park DW; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Shin ES; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Koo BK; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Nam CW; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Doh JH; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Kim JH; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Chae IH; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Yoon JH; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Her SH; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Seung KB; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Chung WY; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Yoo SY; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Lee JB; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Choi SW; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Park K; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Hong TJ; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Lee SY; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Han M; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Lee PH; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Kang SJ; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Lee SW; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Kim YH; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Lee CW; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Park SW; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
  • Park SJ; From Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (J.-M.A., D.-W.P., M.H., PH.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., S.-J.P.); Ulsan University Hospital, South Korea (E.-S.S.); Seoul National University Hospital, South Korea (B.-K.K.); Ke
Circulation ; 135(23): 2241-2251, 2017 Jun 06.
Article in En | MEDLINE | ID: mdl-28356440
BACKGROUND: We evaluated the prognosis of deferred and revascularized coronary stenoses after fractional flow reserve (FFR) measurement to assess its revascularization threshold in clinical practice. METHODS: The IRIS-FFR registry (Interventional Cardiology Research In-cooperation Society Fractional Flow Reserve) prospectively enrolled 5846 patients with ≥1coronary lesion with FFR measurement. Revascularization was deferred in 6468 lesions and performed in 2165 lesions after FFR assessment. The primary end point was major adverse cardiac events (cardiac death, myocardial infarction, and repeat revascularization) at a median follow-up of 1.9 years and analyzed on a per-lesion basis. A marginal Cox model accounted for correlated data in patients with multiple lesions, and a model to predict per-lesion outcomes was adjusted for confounding factors. RESULTS: For deferred lesions, the risk of major adverse cardiac events demonstrated a significant, inverse relationship with FFR (adjusted hazard ratio, 1.06; 95% confidence interval, 1.05-1.08; P<0.001). However, this relationship was not observed in revascularized lesions (adjusted hazard ratio, 1.00; 95% confidence interval, 0.98-1.02; P=0.70). For lesions with FFR ≥0.76, the risk of major adverse cardiac events was not significantly different between deferred and revascularized lesions. Conversely, in lesions with FFR ≤0.75, the risk of major adverse cardiac events was significantly lower in revascularized lesions than in deferred lesions (for FFR 0.71-0.75, adjusted hazard ratio, 0.47; 95% confidence interval, 0.24-0.89; P=0.021; for FFR ≤0.70, adjusted hazard ratio 0.47; 95% confidence interval, 0.26-0.84; P=0.012). CONCLUSIONS: This large, prospective registry showed that the FFR value was linearly associated with the risk of cardiac events in deferred lesions. In addition, revascularization for coronary artery stenosis with a low FFR (≤0.75) was associated with better outcomes than the deferral, whereas for a stenosis with a high FFR (≥0.76), medical treatment would be a reasonable and safe treatment strategy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01366404.
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Full text: 1 Database: MEDLINE Main subject: Societies, Medical / Coronary Artery Disease / Cardiology / Registries / Fractional Flow Reserve, Myocardial / Myocardial Revascularization Type of study: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: Circulation Year: 2017 Type: Article
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Full text: 1 Database: MEDLINE Main subject: Societies, Medical / Coronary Artery Disease / Cardiology / Registries / Fractional Flow Reserve, Myocardial / Myocardial Revascularization Type of study: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: Circulation Year: 2017 Type: Article