Author + information
- Jung-Min Ahn1,
- Se Hun Kang1,
- Tae-Hoon Kim2,
- Frederik Zimmermann3,
- Nils Johnson4,
- Eun-Seok Shin5,
- Bon-Kwon Koo6,
- Pil Hyung Lee1,
- Duk-Woo Park1,
- Soo-Jin Kang1,
- Seung-Whan Lee1,
- Young-Hak Kim1,
- Cheol Whan Lee1,
- Seong-Wook Park1,
- Nico Pijls7 and
- Seung-Jung Park1
- 1Asan Medical Center, Seoul, Korea, Republic of
- 2Sejong General Hospital, Bucheon, Gyeonggi, Korea, Republic of
- 3Catharina Hospital Eindoven, Eindhoven, Netherlands
- 4McGovern Medical School at UTHealth, Houston, Texas, United States
- 5Ulsan University Hospital, Ulsan, Korea, Republic of
- 6Seoul National University Hospital, Seoul, Korea, Republic of
- 7Catharina Hospital, Eindhoven, Netherland
Fractional flow reserve (FFR) has proven to be of prognostic and therapeutic value. However, long-term prognostic value of coronary flow reserve (CFR) in coronary artery disease remains unclear. This study sought to investigate prognostic value and clinical utility of FFR and CFR measurement in coronary artery disease to predict outcome.
From prospective multicenter IRIS-FFR (the Interventional Cardiology Research Incooperation Society-Fractional Flow Reserve) registry, a total of 2088 lesions in 1092 patients were included in this study. Based on baseline and hyperemic Pd/Pa, we estimated boundary of CFR and classified lesions as low CFR group (<2) and high CFR group (≥2). Primary endpoint was major adverse cardiac events (MACE: a composite of cardiac death, myocardial infarction, and repeat revascularization). Primary endpoint was analyzed on per-lesion basis.
During a median follow-up of 1.9 years (interquartile range: 1.0 year to 3.0 years), MACE occurred in 5.7% of lesions with FFR ≤0.80 vs. 2.5% of lesions with FFR >0.80 (adjusted hazard ratio [aHR]: 2.46, 95% confidence interval [CI]: 1.40 to 4.31; P=0.002). By contrast, the incidence of MACE did not differ between lesions with CFR<2 vs. CFR≥2 (4.0% vs. 4.0%; aHR: 0.93, CI: 0.59 to 1.48; P=0.76). Incorporation of FFR significantly improved global chi square for the prediction of MACE (38.8 to 48.1, P=0.002). However, CFR had no incremental utility to classify long-term risk (48.1 to 48.2, P>0.99).
In this large prospective registry enrolling 2088 coronary stenosis, FFR was strongly associated with clinical outcome. In contrast, a relationship between CFR and occurrence of clinical event could not be determined.
IMAGING: FFR and Physiologic Lesion Assessment