Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease
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- Julien Adjedj
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- Bernard De Bruyne
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- Vincent Floré
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- Giuseppe Di Gioia
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- Angela Ferrara
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- Mariano Pellicano
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- Gabor G. Toth
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- Jozef Bartunek
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- Marc Vanderheyden
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- Guy R. Heyndrickx
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- William Wijns
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
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- Emanuele Barbato
- From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
抄録
<jats:sec> <jats:title>Background—</jats:title> <jats:p>The fractional flow reserve (FFR) value of 0.75 has been validated against ischemic testing, whereas the FFR value of 0.80 has been widely accepted to guide clinical decision making. However, revascularization when FFR is 0.76 to 0.80, within the so-called gray zone, is still debatable.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> From February 1997 to June 2013, all patients with single-segment disease and an FFR value within the gray zone or within the 2 neighboring FFR strata (0.70–0.75 and 0.81–0.85) were included. Study end points consisted of major adverse cardiovascular events (death, myocardial infarction, and any revascularization) up to 5 years. Of 17 380 FFR measurements, 1459 patients were included. Of them, 449 patients were treated with revascularization and 1010 patients were treated with medical therapy. In the gray zone, the major adverse cardiovascular events rate was similar (37 [13.9%] versus 21 [11.2%], respectively; <jats:italic>P</jats:italic> =0.3) between medical therapy and revascularization, whereas a strong trend toward a higher rate of death or myocardial infarction (25 [9.4] versus 9 [4.8], <jats:italic>P</jats:italic> =0.06) and overall death (20 [7.5] versus 6 [3.2], <jats:italic>P</jats:italic> =0.059) was observed in the medical therapy group. Among medical therapy patients, a significant step-up increase in major adverse cardiovascular events rate was observed across the 3 FFR strata, especially with proximal lesion location. In revascularization patients, the major adverse cardiovascular events rate was not different across the 3 FFR strata. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>FFR in and around the gray zone bears a major prognostic value, especially in proximal lesions. These data confirm that FFR≤0.80 is valid to guide clinical decision making.</jats:p> </jats:sec>
収録刊行物
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- Circulation
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Circulation 133 (5), 502-508, 2016-02-02
Ovid Technologies (Wolters Kluwer Health)