TY - JOUR
T1 - Angiography versus hemodynamics to predict the natural history of coronary stenoses
T2 - Fractional flow reserve versus angiography in multivessel evaluation 2 substudy
AU - Ciccarelli, Giovanni
AU - Barbato, Emanuele
AU - Toth, Gabor G.
AU - Gahl, Brigitta
AU - Xaplanteris, Panagiotis
AU - Fournier, Stephane
AU - Milkas, Anastasios
AU - Bartunek, Jozef
AU - Vanderheyden, Marc
AU - Pijls, Nico
AU - Tonino, Pim
AU - Fearon, William F.
AU - Jüni, Peter
AU - De Bruyne, Bernard
PY - 2018/4/3
Y1 - 2018/4/3
N2 - 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.
AB - 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.
KW - angiography
KW - coronary artery disease
KW - fractional flow reserve
KW - percutaneous coronary intervention
KW - Coronary Stenosis/mortality
KW - Follow-Up Studies
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Kaplan-Meier Estimate
KW - Proportional Hazards Models
KW - Male
KW - Coronary Angiography
KW - Fractional Flow Reserve, Myocardial/physiology
KW - Female
KW - Aged
KW - Hemodynamics
UR - http://www.scopus.com/inward/record.url?scp=85049569734&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.117.028782
DO - 10.1161/CIRCULATIONAHA.117.028782
M3 - Article
C2 - 29162610
AN - SCOPUS:85049569734
SN - 0009-7322
VL - 137
SP - 1475
EP - 1485
JO - Circulation
JF - Circulation
IS - 14
ER -