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논문 기본 정보

자료유형
학술저널
저자정보
Joo Myung Lee (Samsung Medical Center) Ki Hong Choi (Samsung Medical Center) Joon-Hyung Doh (Inje University Ilsan Paik Hospital) Chang-Wook Nam (Keimyung University) Eun-Seok Shin (Ulsan University Hospital) Masahiro Hoshino (Tsuchiura Kyodo General Hospital) Tadashi Murai (Tsuchiura Kyodo General Hospital) Taishi Yonetsu (Tokyo Medical and Dental University) Hernán Mejía-Rentería (Hospital Clinico San Carlos) Tsunekazu Kakuta (Tsuchiura Kyodo General Hospital) Javier Escaned (Hospital Clinico San Carlos) Bon-Kwon Koo (Seoul National University)
저널정보
대한심장학회 Korean Circulation Journal Korean Circulation Journal Vol.50 No.10
발행연도
2020.1
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890 - 903 (14page)

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Background and Objectives: Recent guideline recommends evaluation using of coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients with functionally insignificant stenosis. We evaluated clinical implications of CFR and IMR in patients with high fractional flow reserve (FFR) and deferred revascularization. Methods: A total of 867 patients (1,152 vessels) consigned to deferred revascularization who underwent comprehensive physiologic assessments were enrolled. Patients with high FFR (>0.80) were categorized by CFR (≤2) and IMR (≥23 U). Clinical outcome was assessed by patient-oriented composite outcome (POCO), a composite of any death, myocardial infarction (MI), and revascularization at 5 years. Results: Patients with low CFR (≤2) showed significantly greater risk of POCO than those with high CFR (>2) in both high-FFR (p=0.024) and low-FFR (p=0.034) groups. In patients with high FFR, those with low CFR and high IMR (overt microvascular disease) displayed the greatest risk of POCO overall (p=0.015), surpassing those with high CFR and low IMR (HR, 2.873; 95% CI, 1.476–5.594; p=0.002) and showing significantly greater risk of cardiac death or MI (HR, 5.662; 95% CI, 1.984–16.154; p=0.001). Overt microvascular disease was independently associated with POCO in the high-FFR population (HR, 2.282; 95% CI, 1.176–4.429; p=0.015). Conclusion: Among patients with deferred revascularization, those with low CFR showed significantly greater risk of POCO than those with high CFR, regardless of FFR. In patients with high FFR, those with overt microvascular disease showed significantly greater risk of POCO and cardiac death or MI at 5-year, compared with the others. Trial Registration: ClinicalTrials.gov Identifier: NCT03690713
#Myocardial ischemia #Coronary artery disease #Fractional flow reserve #Coronary flow reserve #Index of microcirculatory resistance #Percutaneous coronary intervention

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참고문헌 (30)

참고문헌 신청
Hachamovitch R / 2002 / Value of stress myocardial perfusion single photon emission computed tomography in patients with normal resting electrocardiograms : an evaluation of incremental prognostic value and cost-effectiveness / Circulation 105:823~829 google schola Xaplanteris P / 2018 / Five-year outcomes with PCI guided by fractional flow reserve / N Engl J Med 379:250~259 google schola Neumann FJ / 2018 / ESC/EACTS Guidelines on myocardial revascularization / Eur Heart J 39:3759 google schola Lee JM / 2016 / Coronary flow reserve and microcirculatory resistance in patients with intermediate coronary stenosis / J Am Coll Cardiol 67:1158~1169 google schola Lee JM / 2018 / Prognostic implication of thermodilution coronary flow reserve in patients undergoing fractional flow reserve measurement / JACC Cardiovasc Interv 11:1423~1433 google schola

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