Abstract
Background: Among patients with documented stable coronary artery disease and in whom no revascularization was performed, we compared the respective values of angiographic diameter stenosis (DS) and fractional flow reserve (FFR) in predicting natural history. Methods: The present analysis included the 607 patients from the FAME 2 trial (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation 2) in whom no revascularization was performed. FFR varied from 0.20 to 1.00 (average 0.74±0.16), and DS (by quantitative coronary analysis) varied from 8% to 98% (average 53±15). The primary end point, defined as vessel-oriented clinical end point (VOCE) at 2 years, was a composite of prospectively adjudicated cardiac death, vessel-related myocardial infarction, vessel-related urgent, and not urgent revascularization. The stenoses were divided into 4 groups according to FFR and %DS values: positive concordance (FFR≤0.80; DS≥50%), negative concordance (FFR>0.80; DS<50%), positive mismatch (FFR≤0.80; DS<50%), and negative mismatch (FFR>0.80; DS≥50%). Results: The rate of VOCE was highest in the positive concordance group (log rank: X 2 =80.96; P=0.001) and lowest in the negative concordance group. The rate of VOCE was higher in the positive mismatch group than in the negative mismatch group (hazard ratio, 0.38; 95% confidence interval, 0.21-0.67; P=0.001). There was no significant difference in VOCE between the positive concordance and positive mismatch groups (FFR≤0.80; hazard ratio, 0.77; 95% confidence interval, 0.57-1.09; P=0.149) and no significant difference in rate of VOCE between the negative mismatch and negative concordance groups (FFR>0.80; hazard ratio, 1.89; 95% confidence interval, 0.96-3.74; P=0.067). Conclusions: In patients with stable coronary disease, physiology (FFR) is a more important determinant of the natural history of coronary stenoses than anatomy (DS). Clinical Trial Registration: URL: https://clinicaltrials.gov. Unique identifier: NCT01132495.
| Original language | English |
|---|---|
| Pages (from-to) | 1475-1485 |
| Number of pages | 11 |
| Journal | Circulation |
| Volume | 137 |
| Issue number | 14 |
| DOIs | |
| Publication status | Published - 3 Apr 2018 |
Funding
Cardiovascular Center, OLV Hospital, Aalst, Belgium (G.C., E.B., P.X., S.F., A.M., J.B., M.V., B.D.B.). Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.). University Heart Centre Graz, Austria (G.G.T.). Department of Clinical Research, CTU Bern, University of Bern, Switzerland (B.G.). Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (N.P., P.T.). Stanford University Medical Center, CA (W.F.F.). Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada (P.J.). Department of Medicine, University of Toronto, Ontario, Canada (P.J.). The Cardiovascular Center Aalst receives grant support from Abbott, Boston Scientific, Biotronik, and St Jude Medical; and receives consulting fees on behalf of Dr De Bruyne from St Jude Medical, Opsens, and Boston Scientific outside of the submitted work. Dr De Bruyne is a shareholder for Siemens, GE, Bayer, Philips, HeartFlow, Edwards Life Sciences, Sanofi, and Omega Pharma. Dr Barbato report research grants and consulting fees from the Cardiovascular Research Institute Aalst (Belgium) on their behalf from Abbott Vascular (St Jude Medical). The other authors report no conflicts of interest.
Keywords
- angiography
- coronary artery disease
- fractional flow reserve
- percutaneous coronary intervention
- Coronary Stenosis/mortality
- Follow-Up Studies
- Humans
- Middle Aged
- Risk Factors
- Kaplan-Meier Estimate
- Proportional Hazards Models
- Male
- Coronary Angiography
- Fractional Flow Reserve, Myocardial/physiology
- Female
- Aged
- Hemodynamics