Author + information
- Received October 2, 2015
- Revision received January 19, 2016
- Accepted January 29, 2016
- Published online April 12, 2016.
- S0735109716006021-a32de0032788c672738be0d367c179cbYuhei Kobayashi, MDa,b,
- S0735109716006021-25765a09d855c6cf26f44ad577d5a53cChang-Wook Nam, MDc,
- S0735109716006021-12bc21d1ab9638197ce4155a34c77ff2Pim A.L. Tonino, MDd,
- S0735109716006021-315fbb6a6bd52b0d8edaa2117a4881b5Takumi Kimura, MD, PhDa,b,
- S0735109716006021-a6eaa60185d41feba1b27cc52047c8fbBernard De Bruyne, MD, PhDe,
- S0735109716006021-ca475822d9383c5755151d84d9b5f03fNico H.J. Pijls, MD, PhDd,
- S0735109716006021-b46efd0ade4f65f6c008e396c4561026William F. Fearon, MDa,b,∗ (, )
- FAME Study Investigators
- aDivision of Cardiovascular Medicine, Stanford University, Stanford, California
- bStanford Cardiovascular Institute, Stanford, California
- cKeimyung University College of Medicine, Dongsan Medical Center, Daegu, South Korea
- dCatharina Hospital, Eindhoven, the Netherlands
- eCardiovascular Center Aalst, Aalst, Belgium
- ↵∗Reprint requests and correspondence:
Dr. William F. Fearon, Division of Cardiovascular Medicine, Stanford University Medical Center, 300 Pasteur Drive, H2103, Stanford, California 94305-5218.
Background The residual SYNTAX score (RSS) and SYNTAX revascularization index (SRI) quantitatively assess angiographic completeness of revascularization for patients with multivessel coronary artery disease. Whether residual angiographic disease remains of prognostic importance after “functionally” complete revascularization with fractional flow reserve (FFR) guidance is unknown.
Objectives This study sought to investigate the prognostic value of the RSS and SRI after FFR-guided functionally complete revascularization.
Methods From the FFR-guided percutaneous coronary intervention (PCI) cohort of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) trial, the RSS and SRI were calculated in 427 patients after functionally complete revascularization. The RSS was defined as the SYNTAX score (SS) recalculated after PCI. The SRI was calculated as: 100 × (1 − RSS/baseline SS) (%). We compared differences in 1- and 2-year outcomes among patients with RSS of 0, >0 to 4, >4 to 8, and >8, and with SRI of 100%, 50% to <100%, and 0 to <50%.
Results The mean baseline SS, RSS, and SRI were 14.4 ± 7.2, 6.5 ± 5.8, and 55.1 ± 32.5%, respectively. Major adverse cardiac events (MACE) at 1 year occurred in 53 patients (12.4%). Patients with MACE had higher SS than those without (18.0 [interquartile range (IQR): 11.0 to 21.0] vs. 12.0 [IQR: 9.0 to 18.0], p = 0.001), but had similar RSS and SRI after PCI (RSS: 6.0 [IQR: 3.0 to 10.0] vs. 5.0 [IQR: 2.0 to 9.5], p = 0.51 and SRI: 60.0% [IQR: 40.9% to 78.9%] vs. 58.8% [IQR: 26.7% to 81.8%], p = 0.24, respectively). Kaplan-Meier analysis showed similar 1-year incidence of MACE with RSS/SRI stratifications (log-rank p = 0.55 and p = 0.54, respectively). Results were similar with 2-year outcome data analysis.
Conclusions After functionally complete revascularization with FFR guidance, residual angiographic lesions that are not functionally significant do not reflect residual ischemia or predict a worse outcome, supporting functionally complete, rather than angiographically complete, revascularization. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [FAME]; NCT00267774)
- fractional flow reserve
- multivessel revascularization
- residual SYNTAX score
- SYNTAX revascularization index
St. Jude Medical sponsored the FAME study. Dr. Kobayashi has received an institutional research fellowship grant from Boston Scientific. Dr. De Bruyne is a consultant for St. Jude Medical, Opsens, and Boston Scientific; and receives institutional research support from Abbott, Medtronic, St. Jude Medical, and Boston Scientific. Dr. Pijls is a consultant for St. Jude Medical and Opsens; and receives institutional research support from Medtronic. Dr. Fearon receives institutional research grants from St. Jude Medical and Medtronic; and is a consultant for Medtronic and HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 2, 2015.
- Revision received January 19, 2016.
- Accepted January 29, 2016.
- American College of Cardiology Foundation