Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Hwang, D; Koo, BK; Zhang, J; Park, J; Yang, S; Kim, M; Yun, JP; Lee, JM; Nam, CW; Shin, ES; Doh, JH; Chen, SL; Kakuta, T; Toth, GG; Piroth, Z; Johnson, NP; Pijls, NHJ; Hakeem, A; Uretsky, BF; Hokama, Y; Tanaka, N; Lim, HS; Ito, T; Matsuo, A; Azzalini, L; Leesar, MA; Neleman, T; van, Mieghem, NM; Diletti, R; Daemen, J; Collison, D; Collet, C; De, Bruyne, B.
Prognostic Implications of Fractional Flow Reserve After Coronary Stenting: A Systematic Review and Meta-analysis.
JAMA Netw Open. 2022; 5(9):e2232842
Doi: 10.1001/jamanetworkopen.2022.32842
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- Co-Autor*innen der Med Uni Graz
- Toth-Gayor Gabor
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- Abstract:
- IMPORTANCE: Fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is generally considered to reflect residual disease. Yet the clinical relevance of post-PCI FFR after drug-eluting stent (DES) implantation remains unclear. OBJECTIVE: To evaluate the clinical relevance of post-PCI FFR measurement after DES implantation. DATA SOURCES: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant published articles from inception to June 18, 2022. STUDY SELECTION: Published articles that reported post-PCI FFR after DES implantation and its association with clinical outcomes were included. DATA EXTRACTION AND SYNTHESIS: Patient-level data were collected from the corresponding authors of 17 cohorts using a standardized spreadsheet. Meta-estimates for primary and secondary outcomes were analyzed per patient and using mixed-effects Cox proportional hazard regression with registry identifiers included as a random effect. All processes followed the Preferred Reporting Items for Systematic Review and Meta-analysis of Individual Participant Data. MAIN OUTCOMES AND MEASURES: The primary outcome was target vessel failure (TVF) at 2 years, a composite of cardiac death, target vessel myocardial infarction (TVMI), and target vessel revascularization (TVR). The secondary outcome was a composite of cardiac death or TVMI at 2 years. RESULTS: Of 2268 articles identified, 29 studies met selection criteria. Of these, 28 articles from 17 cohorts provided data, including a total of 5277 patients with 5869 vessels who underwent FFR measurement after DES implantation. Mean (SD) age was 64.4 (10.1) years and 4141 patients (78.5%) were men. Median (IQR) post-PCI FFR was 0.89 (0.84-0.94) and 690 vessels (11.8%) had a post-PCI FFR of 0.80 or below. The cumulative incidence of TVF was 340 patients (7.2%), with cardiac death or TVMI occurring in 111 patients (2.4%) at 2 years. Lower post-PCI FFR significantly increased the risk of TVF (adjusted hazard ratio [HR] per 0.01 FFR decrease, 1.04; 95% CI, 1.02-1.05; P < .001). The risk of cardiac death or MI also increased inversely with post-PCI FFR (adjusted HR, 1.03; 95% CI, 1.00-1.07, P = .049). These associations were consistent regardless of age, sex, the presence of hypertension or diabetes, and clinical diagnosis. CONCLUSIONS AND RELEVANCE: Reduced FFR after DES implantation was common and associated with the risks of TVF and of cardiac death or TVMI. These results indicate the prognostic value of post-PCI physiologic assessment after DES implantation.
- Find related publications in this database (using NLM MeSH Indexing)
- Coronary Angiography - administration & dosage
- Death - administration & dosage
- Drug-Eluting Stents - adverse effects
- Female - administration & dosage
- Fractional Flow Reserve, Myocardial - physiology
- Humans - administration & dosage
- Male - administration & dosage
- Middle Aged - administration & dosage
- Myocardial Infarction - etiology
- Percutaneous Coronary Intervention - adverse effects
- Prognosis - administration & dosage
- Treatment Outcome - administration & dosage