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)

Jung Min Ahn, Duk Woo Park, Eun Seok Shin, Bon Kwon Koo, Chang Wook Nam, Joon Hyung Doh, Jun Hong Kim, In Ho Chae, Junghan Yoon, Sung Ho Her, Ki Bae Seung, Woo Young Chung, Sang Yong Yoo, Jin Bae Lee, Si Wan Choi, Kyungil Park, Taek Jong Hong, Sang Yeub Lee, Minkyu Han, Pil Hyung Lee & 6 others Soo Jin Kang, Seung Whan Lee, Young Hak Kim, Cheol Whan Lee, Seong Wook Park, Seung Jung Park

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2241-2251
Number of pages11
JournalCirculation
Volume135
Issue number23
DOIs
Publication statusPublished - 2017 Jun 6

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Cardiology
Registries
Coronary Artery Disease
Confidence Intervals
Coronary Stenosis
Research
Proportional Hazards Models
Pathologic Constriction
Myocardial Infarction
Clinical Trials
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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, Junghan ; 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. / 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). In: Circulation. 2017 ; Vol. 135, No. 23. pp. 2241-2251.
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title = "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)",
abstract = "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.",
author = "Ahn, {Jung Min} and Park, {Duk Woo} and Shin, {Eun Seok} and Koo, {Bon Kwon} and Nam, {Chang Wook} and Doh, {Joon Hyung} and Kim, {Jun Hong} and Chae, {In Ho} and Junghan Yoon and Her, {Sung Ho} and Seung, {Ki Bae} and Chung, {Woo Young} and Yoo, {Sang Yong} and Lee, {Jin Bae} and Choi, {Si Wan} and Kyungil Park and Hong, {Taek Jong} and Lee, {Sang Yeub} and Minkyu Han and Lee, {Pil Hyung} and Kang, {Soo Jin} and Lee, {Seung Whan} and Kim, {Young Hak} and Lee, {Cheol Whan} and Park, {Seong Wook} and Park, {Seung Jung}",
year = "2017",
month = "6",
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doi = "10.1161/CIRCULATIONAHA.116.024433",
language = "English",
volume = "135",
pages = "2241--2251",
journal = "Circulation",
issn = "0009-7322",
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Ahn, JM, Park, DW, Shin, ES, Koo, BK, Nam, CW, Doh, JH, Kim, JH, Chae, IH, Yoon, J, Her, SH, Seung, KB, Chung, WY, Yoo, SY, Lee, JB, Choi, SW, Park, K, Hong, TJ, Lee, SY, Han, M, Lee, PH, Kang, SJ, Lee, SW, Kim, YH, Lee, CW, Park, SW & Park, SJ 2017, '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)', Circulation, vol. 135, no. 23, pp. 2241-2251. https://doi.org/10.1161/CIRCULATIONAHA.116.024433

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, Junghan; 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.

In: Circulation, Vol. 135, No. 23, 06.06.2017, p. 2241-2251.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Fractional Flow Reserve and Cardiac Events in Coronary Artery Disease

T2 - Data from a Prospective IRIS-FFR Registry (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve)

AU - Ahn, Jung Min

AU - Park, Duk Woo

AU - Shin, Eun Seok

AU - Koo, Bon Kwon

AU - Nam, Chang Wook

AU - Doh, Joon Hyung

AU - Kim, Jun Hong

AU - Chae, In Ho

AU - Yoon, Junghan

AU - Her, Sung Ho

AU - Seung, Ki Bae

AU - Chung, Woo Young

AU - Yoo, Sang Yong

AU - Lee, Jin Bae

AU - Choi, Si Wan

AU - Park, Kyungil

AU - Hong, Taek Jong

AU - Lee, Sang Yeub

AU - Han, Minkyu

AU - Lee, Pil Hyung

AU - Kang, Soo Jin

AU - Lee, Seung Whan

AU - Kim, Young Hak

AU - Lee, Cheol Whan

AU - Park, Seong Wook

AU - Park, Seung Jung

PY - 2017/6/6

Y1 - 2017/6/6

N2 - 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.

AB - 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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DO - 10.1161/CIRCULATIONAHA.116.024433

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EP - 2251

JO - Circulation

JF - Circulation

SN - 0009-7322

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