Author + information
- Ki Hong Choi1,
- Joo Myung Lee2,
- Bon-Kwon Koo3,
- Chang-Wook Nam4,
- Eun-Seok Shin5,
- Joon-Hyung Doh6,
- Doyeon Hwang3 and
- Jonghanne Park7
- 1Samsung Medical Center, Seoul, Korea, Republic of
- 2Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of
- 3Seoul National University Hospital, Seoul, Korea, Republic of
- 4Keimyung University Dongsan Medical Center, Daegu, Korea, Republic of
- 5Ulsan University Hospital, Ulsan, Korea, Republic of
- 6Inje University Ilsan Paik Hospital, Seoul, Korea, Republic of
- 7Ministry of Health and Welfare, Seoul, Korea, Republic of
Incomplete revascularization (IR) is associated with poor clinical outcomes in patients who have undergone percutaneous coronary intervention. This study investigated the prognostic implication of functional IR and residual functional SYNTAX score (rFSS) in comparison with 3-vessel fractional flow reserve (FFR) and residual SYNTAX score (rSS).
385 patients who underwent 3-vessel FFR measurement after stent implantation were included in this study. The rFSS was defined as rSS measured only in vessels with FFR≤0.8. The study population was divided into the functional IR group (rFSS≥1) and the functional complete revascularization (CR) group (rFSS=0). The primary outcome was major adverse cardiac events (MACE, a composite of cardiac death, myocardial infarction (MI) and ischemia-driven revascularization) at 2 years.
The functional CR was achieved in 283 patients (73.5%). At 2-year follow-up, the functional IR group showed a significantly higher risk of MACE (4.2% vs. 14.6%, HR 4.09, 95% CI 1.82-9.21, p<0.001) and cardiac death or MI (0.8% vs. 6.2%, HR 7.52, 95% CI 1.46-38.78, p=0.016) than the functional CR group. In a multivariable adjusted model, functional IR was an independent predictor of MACE (adjusted HR 4.08, 95% CI 1.40-11.89, p=0.010) and cardiac death or MI (adjusted HR 13.04, 95% CI 1.67-101.72, p=0.014). The rFSS showed a significant association with estimated 2-year MACE rate (HR 1.09 per 1 increase, 95% CI 1.02-1.17, p=0.018). When added to clinical risk factors, rFSS showed the highest integrated discrimination improvement value for MACE (3.5%, p=0.002) and cardiac death or MI (1.4%, p=0.022) among 3-vessel FFR, rSS, and rFSS.
Patients with functional IR showed significantly higher rates of 2-year MACE and cardiac death or MI than those with functional CR. Combined anatomical and physiological scoring system (rFSS) after stent implantation better discriminated the risk of adverse events than anatomical or physiological assessments alone.
IMAGING: FFR and Physiologic Lesion Assessment