- Email: [email protected]
TCT-66 Prognosis of Deferred Non-culprit Lesions According to Fractional Flow Reserve in Patients with Acute Coronary Syndrome
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017
as a staged procedure. All BPAs (n¼293) were performed via the femoral approach. NT-proBNP was measured in all patients before every BPA and after a 6-month follow-up period. RESULTS All patients (age 64.7 13.5 yrs) were at WHO functional class III with elevated systolic RV pressure (68.2 14.7 mmHg) at baseline. Almost half (46.2%) of the patients had been previously medically treated for pulmonary hypertension. During BPA we observed 6 dissections of a segment artery, which we treated conservatively. Five patients developed reperfusion oedema with the need for non-invasive ventilation. During 18 procedures patients developed hemoptysis. One patient died two weeks after hospital discharge due to hematothorax. After completion of BPA treatment (mean 5.1 [SD 1.5] procedures) in 52 patients the mean pulmonary artery pressure (mPAP) was significantly decreased (37.0 [IQR 25.5-44.0] mmHg vs. 30.0 [IQR 19.535.5] mmHg; P<0.0001). After BPA 80% of the patients showed an improved WHO functional class (P<0.05) and a greater 6-minutewalk distance (P<0.05). We observed a substantial decrease in NTproBNP levels in these patients (1120.0 ng/L [IQR 215.2-1969.0] vs. 352.0 ng/L [IQR 115.4-1074.0]; P<0.0001). In patients (n¼6) without a decrease in mPAP, there was no decrease in NT-proBNP (1548 ng/L [IQR 876-2236] vs. 1485 ng/L [IQR 698-2023]; P¼0.67). In patients (n¼29) with completed BPA treatment the significant decrease in mPAP persisted at the 6-month follow-up compared with the mPAP prior to the first BPA (30.5 [25.0-39.8] mmHg vs. 36.5 [25.0-44.5] mmHg; P¼0.001). NT-proBNP decreased further after the 6-month follow-up, suggesting further right ventricular remodelling (450 ng/L [IQR 182-1327] vs. 175 ng/L [IQR 104-539]; P¼0.003). CONCLUSION BPA is a valuable treatment option with low periprocedural risk for patients with inoperable CTEPH that shows persistent success during mid-term follow-up (survival rate 98%). Measurement of serum NT-proBNP levels allows estimation of the procedural success. CATEGORIES ENDOVASCULAR: Peripheral Vascular Disease and Intervention
PHYSIOLOGIC LESION ASSESSMENT AND CLINICAL OUTCOMES
Abstract nos: 65 - 68 TCT-65 Reclassification of revascularization strategy with instantaneous wave-free ratio and fractional flow reserve: A report from the iFR-SWEDEHEART study Pontus Andell,1 Ole Frobert,2 Evald Christiansen,3 Ingibjorg Gudmundsdottir,4 Lennart Sandhall,5 David Erlinge,6 Matthias Götberg7 1 Department of Cardiology, Lund University, Skåne University Hospital Lund, Lund, Sweden; 2Universitetssjukhuset Orebro, Orebro, Sweden; 3Aarhus University Hospital, Aarhus, Denmark; 4University hospital Iceland, Reykjavik, Iceland; 5Helsingborg Hospital, Helsingborg, Sweden; 6Skane University Hospital, Lund, Sweden; 7 Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden BACKGROUND Instantaneous wave-free ratio (iFR) is an index used to measure the severity of coronary artery stenosis. iFR has been shown to be noninferior to fractional flow reserve (FFR) in two large prospective and randomized controlled trials. Reclassification of coronary revascularization strategy, i.e. how coronary physiology changes treatment decision is well-studied with FFR, but similar reports on iFR are lacking. METHODS The iFR-SWEDEHEART study enrolled 2037 participants with stable angina or acute coronary syndrome with an indication for physiologically-guided assessment of coronary artery stenosis. Eligible patients were randomized to
revascularization guided by either iFR or FFR. The treating interventionists had to enter both the preliminary treatment decision (i.e. optimal medical therapy (OMT), percutaneous coronary intervention (PCI) of one, two, or three vessels, or coronary artery bypass grafting (CABG)) based on the angiogram before iFR/FFR, and the final treatment decision determined by the iFR/FFR measurements. RESULTS A total of 1012 (iFR) and 1007 (FFR) patients underwent physiologically-guided revascularization. In the iFR and FFR groups, angiogram-based a priori strategies were OMT in 37.8% and 34.7%, PCI in 54.1% and 57.7% and CABG in 8.1% and 7.6%, respectively (p¼0.25). All patients were mandatorily treated according to the iFR/FFR measurements. The iFR and FFR guided final treatment strategies were OMT in 46.9% and 43.3%, PCI in 43.9% and 45.4% and CABG in 9.2% and 11.3%, respectively. A total of 405 patients (40.1%) were reclassified with iFR and 409 patients (40.7%) were reclassified with FFR (p¼0.78). The majority of reclassifications were deferrals of PCI into OMT in both the IFR (31.4%) and FFR (29.0%) groups, respectively (p¼0.36). CONCLUSION Reclassification of coronary revascularization strategy using iFR or FFR was common and occurred in approximately 40% of patients. There were no significant differences in reclassification patterns between iFR or FFR and the most frequent reclassification was deferral of PCI in favor of OMT regardless of measurement modality. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
TCT-66 Prognosis of Deferred Non-culprit Lesions According to Fractional Flow Reserve in Patients with Acute Coronary Syndrome Ki Hong Choi,1 Joo Myung Lee,2 Bon-Kwon Koo,3 Eun-Seok Shin,4 Chang-Wook Nam,5 Joon-Hyung Doh,6 Doyeon Hwang,3 Jonghanne Park,7 Hong-Seok Lim,8 Myeong-Ho Yoon,9 Seung-Jea Tahk8 1 Samsung Medical Center, Seoul, Korea, Republic of; 2Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of; 3Seoul National University Hospital, Seoul, Korea, Republic of; 4Ulsan University Hospital, Ulsan, Korea, Republic of; 5Keimyung University Dongsan Medical Center, Daegu, Korea, Republic of; 6Inje University Ilsan Paik Hospital, Seoul, Korea, Republic of; 7Ministry of Health and Welfare, Seoul, Korea, Republic of; 8Ajou University Medical Center, Suwon, Korea, Republic of; 9Department of Cardiology, Ajou University School of Medicine, Suwon, Korea, Republic of BACKGROUND There are limited data on the prognosis of deferred non-culprit lesion in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). We investigated the prognosis of deferred non-culprit lesion in ACS patients, compared with deferred lesions in patients with stable coronary artery disease (SCAD) on the basis of FFR. METHODS The clinical outcomes of 449 non-culprit lesions (301 ACS patients) were compared with 2,484 lesions (1,295 SCAD patients) in which revascularization was deferred on the basis of a high FFR (>0.80). The primary outcome was major adverse cardiac events (MACE), a composite of cardiac death, target vessel-related myocardial infarction (MI) and ischemia-driven revascularization. RESULTS Among the ACS population, 65.8% presented with unstable angina and 34.2% were with non-ST segment elevation MI. Mean angiographic % diameter stenosis and FFR of the deferred lesions were 39.315.0% and 0.920.06, respectively. During the median follow-up duration of 722.0 days, the deferred non-culprit lesions of ACS patient showed significantly higher rate of MACE (3.8% vs. 1.6%, HR 2.97, 95% CI 1.23-7.17, p¼0.016). Regardless of the range of FFR in the deferred lesions (0.81-0.85, 0.86-0.90, 0.910.95, and 0.95-1.00), non-culprit lesion of ACS showed more than 2folds higher rates of MACE than that of SCAD. ACS was the most powerful independent predictor of MACE (HR 2.74, 95% CI 1.136.64, p¼0.026).
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significant trends of decrease in 3-vessel FFR (p <0.001 for trend) and increase in SYNTAX score (p <0.001 for trend). Group 1 and Group 2 showed a similar risk of 2-year MACE (2.6% vs. 2.0%; HR, 1.24; 95% CI 0.45-3.42; p¼0.67). However, Group 3 showed a significantly higher risk than Group 1 (7.3%; HR, 3.81; 95% CI 1.23-11.8; p¼0.02). A multivariable regression model showed that the risk of Group 3 was comparable to that of Group 4 (HR, 1.07; 95% CI, 0.44-2.62; p ¼ 0.87).
CONCLUSION Compared to the deferred lesions of SCAD patients, deferred non-culprit lesion of ACS on the basis of FFR showed a higher rate of clinical events regardless of FFR range. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-67 Clinical Relevance of Functionally Insignificant Moderate Coronary Artery Stenosis Assessed by 3-vessel Fractional Flow Reserve Measurement Jonghanne Park,1 Joo Myung Lee,2 Bon-Kwon Koo,3 Eun-Seok Shin,4 Chang-Wook Nam,5 Joon-Hyung Doh,6 Doyeon Hwang,3 Xinyang Hu,7 Jianan Wang,8 Fei Ye,9 Shaoliang Chen,10 Junqing Yang,11 Jiyan Chen,12 Nobuhiro Tanaka,13 Hiroyoshi Yokoi,14 Hitoshi Matsuo,15 Hiroaki Takashima,16 Yasutsugu Shiono,17 Takashi Akasaka18 1 Ministry of Health and Welfare, Seoul, Korea, Republic of; 2Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of; 3Seoul National University Hospital, Seoul, Korea, Republic of; 4Ulsan University Hospital, Ulsan, Korea, Republic of; 5Keimyung University Dongsan Medical Center, Daegu, Korea, Republic of; 6Inje University Ilsan Paik Hospital, Seoul, Korea, Republic of; 7The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; 8 The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; 9Nanjing First Hospital, Nanjing, China; 10Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; 11Guangdong General Hospital, Guagnzhou, Guangdong, China; 12Guangdong General Hospital, Guangzhou, Guangdong, China; 13Tokyo Medical University, Tokyo, Japan; 14 Kokura Memorial Hospital, Kitakyushu, Japan; 15Gifu Heart Center, Gifu, Japan; 16Aichi Medical University, Nagakute, Japan; 17Imperial College London, London, United Kingdom; 18Wakayama Medical University, Wakayama, Japan BACKGROUND The risk of functionally insignificant lesions in multiple coronary vessels is largely unknown. We investigated the prognostic implication of severity and extent of coronary artery disease (CAD) using fractional flow reserve (FFR) measured in all 3 major epicardial arteries. METHODS 1,136 patients underwent 3-vessel FFR measurement. The vessel was defined to have moderate CAD when the FFR was within the range of the lowest quartile (FFR, 0.81-0.87) among 2,891 vessels with high FFR (>0.8). The patients were classified into ‘No apparent CAD’ (FFR>0.87 in all 3 vessels, Group 1), ‘Moderate CAD affecting 1vessel’ (Group 2), ‘Moderate CAD affecting multi-vessels’ (Group 3), and ‘Functionally significant CAD’ (FFR0.80 in any vessel, Group 4). The primary endpoint was 2-year major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction and ischemia-driven revascularization. RESULTS 43% of the total patients had moderate CAD (Group 2: 403/ 1136, 35.5%; Group 3: 84/1136, 7.4%). From Group 1 to 4, there were
CONCLUSION Global physiologic assessment by 3-vessel FFR can enable the identification of multi-vessel moderate CAD. The prognostic implication of multi-vessel moderate CAD was comparable to that of functionally significant CAD. (3V FFR-FRIENDS study, NCT01621438). CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-68 Clinical Outcomes According to Fractional Flow Reserve or Instantaneous Wave-Free Ratio in Deferred Lesions Joo Myung Lee,1 Eun-Seok Shin,2 Chang-Wook Nam,3 Joon-Hyung Doh,4 Doyeon Hwang,5 Jonghanne Park,6 Ahn Chul,7 Bon-Kwon Koo5 1 Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of; 2Ulsan University Hospital, Ulsan, Korea, Republic of; 3Keimyung University Dongsan Medical Center, Daegu, Korea, Republic of; 4Inje University Ilsan Paik Hospital, Seoul, Korea, Republic of; 5Seoul National University Hospital, Seoul, Korea, Republic of; 6Ministry of Health and Welfare, Seoul, Korea, Republic of; 7FDA-CDRH, Silver Spring, Maryland, United States BACKGROUND Invasive physiologic index such as fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) are used in clinical practice to select ischemia-causing stenosis and to guide the treatment strategy for patients with coronary artery disease. We investigated 2-year clinical outcomes according to FFR and iFR values in deferred lesions. METHODS From 3V FFR-FRIENDS study, 821 deferred lesions (374 patients) with available both FFR and iFR were included in this study. The primary outcome was major adverse cardiac events (MACE, a composite of cardiac death, myocardial infarction and ischemia-driven revascularization) at 2 years. The rates of MACE were compared according to FFR using cut-off value 0.80 and iFR using cut-off value 0.90. The rate of MACE was also compared among classifications according to FFR and iFR into concordant normal (Group 1: FFR>0.80 and iFR0.90), high FFR and low iFR (Group 2: FFR>0.80 and iFR<0.90), low FFR and high iFR (Group 3: FFR0.80 and iFR0.90) and concordant abnormal (Group 4: FFR0.80 and iFR<0.90). RESULTS Deferred lesions with low FFR (0.80) or low iFR (<0.90) showed significantly higher rates of 2-year MACE, compared with high FFR (>0.80) or high iFR (0.90), respectively (7.2% in low FFR vs. 2.4% in high FFR, p<0.001; 8.1% in low iFR vs. 2.4% in high iFR, p<0.001). Both FFR and iFR showed significant association with occurrence of MACE as continuous values (HR of FFR 0.570, 95% CI 0.337-0.963, p<0.001; HR of iFR 0.350, 95% CI 0.217-0.567, p<0.001).
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017
as a staged procedure. All BPAs (n¼293) were performed via the femoral approach. NT-proBNP was measured in all patients before every BPA and after a 6-month follow-up period. RESULTS All patients (age 64.7 13.5 yrs) were at WHO functional class III with elevated systolic RV pressure (68.2 14.7 mmHg) at baseline. Almost half (46.2%) of the patients had been previously medically treated for pulmonary hypertension. During BPA we observed 6 dissections of a segment artery, which we treated conservatively. Five patients developed reperfusion oedema with the need for non-invasive ventilation. During 18 procedures patients developed hemoptysis. One patient died two weeks after hospital discharge due to hematothorax. After completion of BPA treatment (mean 5.1 [SD 1.5] procedures) in 52 patients the mean pulmonary artery pressure (mPAP) was significantly decreased (37.0 [IQR 25.5-44.0] mmHg vs. 30.0 [IQR 19.535.5] mmHg; P<0.0001). After BPA 80% of the patients showed an improved WHO functional class (P<0.05) and a greater 6-minutewalk distance (P<0.05). We observed a substantial decrease in NTproBNP levels in these patients (1120.0 ng/L [IQR 215.2-1969.0] vs. 352.0 ng/L [IQR 115.4-1074.0]; P<0.0001). In patients (n¼6) without a decrease in mPAP, there was no decrease in NT-proBNP (1548 ng/L [IQR 876-2236] vs. 1485 ng/L [IQR 698-2023]; P¼0.67). In patients (n¼29) with completed BPA treatment the significant decrease in mPAP persisted at the 6-month follow-up compared with the mPAP prior to the first BPA (30.5 [25.0-39.8] mmHg vs. 36.5 [25.0-44.5] mmHg; P¼0.001). NT-proBNP decreased further after the 6-month follow-up, suggesting further right ventricular remodelling (450 ng/L [IQR 182-1327] vs. 175 ng/L [IQR 104-539]; P¼0.003). CONCLUSION BPA is a valuable treatment option with low periprocedural risk for patients with inoperable CTEPH that shows persistent success during mid-term follow-up (survival rate 98%). Measurement of serum NT-proBNP levels allows estimation of the procedural success. CATEGORIES ENDOVASCULAR: Peripheral Vascular Disease and Intervention
PHYSIOLOGIC LESION ASSESSMENT AND CLINICAL OUTCOMES
Abstract nos: 65 - 68 TCT-65 Reclassification of revascularization strategy with instantaneous wave-free ratio and fractional flow reserve: A report from the iFR-SWEDEHEART study Pontus Andell,1 Ole Frobert,2 Evald Christiansen,3 Ingibjorg Gudmundsdottir,4 Lennart Sandhall,5 David Erlinge,6 Matthias Götberg7 1 Department of Cardiology, Lund University, Skåne University Hospital Lund, Lund, Sweden; 2Universitetssjukhuset Orebro, Orebro, Sweden; 3Aarhus University Hospital, Aarhus, Denmark; 4University hospital Iceland, Reykjavik, Iceland; 5Helsingborg Hospital, Helsingborg, Sweden; 6Skane University Hospital, Lund, Sweden; 7 Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden BACKGROUND Instantaneous wave-free ratio (iFR) is an index used to measure the severity of coronary artery stenosis. iFR has been shown to be noninferior to fractional flow reserve (FFR) in two large prospective and randomized controlled trials. Reclassification of coronary revascularization strategy, i.e. how coronary physiology changes treatment decision is well-studied with FFR, but similar reports on iFR are lacking. METHODS The iFR-SWEDEHEART study enrolled 2037 participants with stable angina or acute coronary syndrome with an indication for physiologically-guided assessment of coronary artery stenosis. Eligible patients were randomized to
revascularization guided by either iFR or FFR. The treating interventionists had to enter both the preliminary treatment decision (i.e. optimal medical therapy (OMT), percutaneous coronary intervention (PCI) of one, two, or three vessels, or coronary artery bypass grafting (CABG)) based on the angiogram before iFR/FFR, and the final treatment decision determined by the iFR/FFR measurements. RESULTS A total of 1012 (iFR) and 1007 (FFR) patients underwent physiologically-guided revascularization. In the iFR and FFR groups, angiogram-based a priori strategies were OMT in 37.8% and 34.7%, PCI in 54.1% and 57.7% and CABG in 8.1% and 7.6%, respectively (p¼0.25). All patients were mandatorily treated according to the iFR/FFR measurements. The iFR and FFR guided final treatment strategies were OMT in 46.9% and 43.3%, PCI in 43.9% and 45.4% and CABG in 9.2% and 11.3%, respectively. A total of 405 patients (40.1%) were reclassified with iFR and 409 patients (40.7%) were reclassified with FFR (p¼0.78). The majority of reclassifications were deferrals of PCI into OMT in both the IFR (31.4%) and FFR (29.0%) groups, respectively (p¼0.36). CONCLUSION Reclassification of coronary revascularization strategy using iFR or FFR was common and occurred in approximately 40% of patients. There were no significant differences in reclassification patterns between iFR or FFR and the most frequent reclassification was deferral of PCI in favor of OMT regardless of measurement modality. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
TCT-66 Prognosis of Deferred Non-culprit Lesions According to Fractional Flow Reserve in Patients with Acute Coronary Syndrome Ki Hong Choi,1 Joo Myung Lee,2 Bon-Kwon Koo,3 Eun-Seok Shin,4 Chang-Wook Nam,5 Joon-Hyung Doh,6 Doyeon Hwang,3 Jonghanne Park,7 Hong-Seok Lim,8 Myeong-Ho Yoon,9 Seung-Jea Tahk8 1 Samsung Medical Center, Seoul, Korea, Republic of; 2Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of; 3Seoul National University Hospital, Seoul, Korea, Republic of; 4Ulsan University Hospital, Ulsan, Korea, Republic of; 5Keimyung University Dongsan Medical Center, Daegu, Korea, Republic of; 6Inje University Ilsan Paik Hospital, Seoul, Korea, Republic of; 7Ministry of Health and Welfare, Seoul, Korea, Republic of; 8Ajou University Medical Center, Suwon, Korea, Republic of; 9Department of Cardiology, Ajou University School of Medicine, Suwon, Korea, Republic of BACKGROUND There are limited data on the prognosis of deferred non-culprit lesion in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). We investigated the prognosis of deferred non-culprit lesion in ACS patients, compared with deferred lesions in patients with stable coronary artery disease (SCAD) on the basis of FFR. METHODS The clinical outcomes of 449 non-culprit lesions (301 ACS patients) were compared with 2,484 lesions (1,295 SCAD patients) in which revascularization was deferred on the basis of a high FFR (>0.80). The primary outcome was major adverse cardiac events (MACE), a composite of cardiac death, target vessel-related myocardial infarction (MI) and ischemia-driven revascularization. RESULTS Among the ACS population, 65.8% presented with unstable angina and 34.2% were with non-ST segment elevation MI. Mean angiographic % diameter stenosis and FFR of the deferred lesions were 39.315.0% and 0.920.06, respectively. During the median follow-up duration of 722.0 days, the deferred non-culprit lesions of ACS patient showed significantly higher rate of MACE (3.8% vs. 1.6%, HR 2.97, 95% CI 1.23-7.17, p¼0.016). Regardless of the range of FFR in the deferred lesions (0.81-0.85, 0.86-0.90, 0.910.95, and 0.95-1.00), non-culprit lesion of ACS showed more than 2folds higher rates of MACE than that of SCAD. ACS was the most powerful independent predictor of MACE (HR 2.74, 95% CI 1.136.64, p¼0.026).
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significant trends of decrease in 3-vessel FFR (p <0.001 for trend) and increase in SYNTAX score (p <0.001 for trend). Group 1 and Group 2 showed a similar risk of 2-year MACE (2.6% vs. 2.0%; HR, 1.24; 95% CI 0.45-3.42; p¼0.67). However, Group 3 showed a significantly higher risk than Group 1 (7.3%; HR, 3.81; 95% CI 1.23-11.8; p¼0.02). A multivariable regression model showed that the risk of Group 3 was comparable to that of Group 4 (HR, 1.07; 95% CI, 0.44-2.62; p ¼ 0.87).
CONCLUSION Compared to the deferred lesions of SCAD patients, deferred non-culprit lesion of ACS on the basis of FFR showed a higher rate of clinical events regardless of FFR range. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-67 Clinical Relevance of Functionally Insignificant Moderate Coronary Artery Stenosis Assessed by 3-vessel Fractional Flow Reserve Measurement Jonghanne Park,1 Joo Myung Lee,2 Bon-Kwon Koo,3 Eun-Seok Shin,4 Chang-Wook Nam,5 Joon-Hyung Doh,6 Doyeon Hwang,3 Xinyang Hu,7 Jianan Wang,8 Fei Ye,9 Shaoliang Chen,10 Junqing Yang,11 Jiyan Chen,12 Nobuhiro Tanaka,13 Hiroyoshi Yokoi,14 Hitoshi Matsuo,15 Hiroaki Takashima,16 Yasutsugu Shiono,17 Takashi Akasaka18 1 Ministry of Health and Welfare, Seoul, Korea, Republic of; 2Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of; 3Seoul National University Hospital, Seoul, Korea, Republic of; 4Ulsan University Hospital, Ulsan, Korea, Republic of; 5Keimyung University Dongsan Medical Center, Daegu, Korea, Republic of; 6Inje University Ilsan Paik Hospital, Seoul, Korea, Republic of; 7The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; 8 The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; 9Nanjing First Hospital, Nanjing, China; 10Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; 11Guangdong General Hospital, Guagnzhou, Guangdong, China; 12Guangdong General Hospital, Guangzhou, Guangdong, China; 13Tokyo Medical University, Tokyo, Japan; 14 Kokura Memorial Hospital, Kitakyushu, Japan; 15Gifu Heart Center, Gifu, Japan; 16Aichi Medical University, Nagakute, Japan; 17Imperial College London, London, United Kingdom; 18Wakayama Medical University, Wakayama, Japan BACKGROUND The risk of functionally insignificant lesions in multiple coronary vessels is largely unknown. We investigated the prognostic implication of severity and extent of coronary artery disease (CAD) using fractional flow reserve (FFR) measured in all 3 major epicardial arteries. METHODS 1,136 patients underwent 3-vessel FFR measurement. The vessel was defined to have moderate CAD when the FFR was within the range of the lowest quartile (FFR, 0.81-0.87) among 2,891 vessels with high FFR (>0.8). The patients were classified into ‘No apparent CAD’ (FFR>0.87 in all 3 vessels, Group 1), ‘Moderate CAD affecting 1vessel’ (Group 2), ‘Moderate CAD affecting multi-vessels’ (Group 3), and ‘Functionally significant CAD’ (FFR0.80 in any vessel, Group 4). The primary endpoint was 2-year major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction and ischemia-driven revascularization. RESULTS 43% of the total patients had moderate CAD (Group 2: 403/ 1136, 35.5%; Group 3: 84/1136, 7.4%). From Group 1 to 4, there were
CONCLUSION Global physiologic assessment by 3-vessel FFR can enable the identification of multi-vessel moderate CAD. The prognostic implication of multi-vessel moderate CAD was comparable to that of functionally significant CAD. (3V FFR-FRIENDS study, NCT01621438). CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-68 Clinical Outcomes According to Fractional Flow Reserve or Instantaneous Wave-Free Ratio in Deferred Lesions Joo Myung Lee,1 Eun-Seok Shin,2 Chang-Wook Nam,3 Joon-Hyung Doh,4 Doyeon Hwang,5 Jonghanne Park,6 Ahn Chul,7 Bon-Kwon Koo5 1 Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of; 2Ulsan University Hospital, Ulsan, Korea, Republic of; 3Keimyung University Dongsan Medical Center, Daegu, Korea, Republic of; 4Inje University Ilsan Paik Hospital, Seoul, Korea, Republic of; 5Seoul National University Hospital, Seoul, Korea, Republic of; 6Ministry of Health and Welfare, Seoul, Korea, Republic of; 7FDA-CDRH, Silver Spring, Maryland, United States BACKGROUND Invasive physiologic index such as fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) are used in clinical practice to select ischemia-causing stenosis and to guide the treatment strategy for patients with coronary artery disease. We investigated 2-year clinical outcomes according to FFR and iFR values in deferred lesions. METHODS From 3V FFR-FRIENDS study, 821 deferred lesions (374 patients) with available both FFR and iFR were included in this study. The primary outcome was major adverse cardiac events (MACE, a composite of cardiac death, myocardial infarction and ischemia-driven revascularization) at 2 years. The rates of MACE were compared according to FFR using cut-off value 0.80 and iFR using cut-off value 0.90. The rate of MACE was also compared among classifications according to FFR and iFR into concordant normal (Group 1: FFR>0.80 and iFR0.90), high FFR and low iFR (Group 2: FFR>0.80 and iFR<0.90), low FFR and high iFR (Group 3: FFR0.80 and iFR0.90) and concordant abnormal (Group 4: FFR0.80 and iFR<0.90). RESULTS Deferred lesions with low FFR (0.80) or low iFR (<0.90) showed significantly higher rates of 2-year MACE, compared with high FFR (>0.80) or high iFR (0.90), respectively (7.2% in low FFR vs. 2.4% in high FFR, p<0.001; 8.1% in low iFR vs. 2.4% in high iFR, p<0.001). Both FFR and iFR showed significant association with occurrence of MACE as continuous values (HR of FFR 0.570, 95% CI 0.337-0.963, p<0.001; HR of iFR 0.350, 95% CI 0.217-0.567, p<0.001).