Angiography Versus Hemodynamics to Predict the Natural History of Coronary Stenoses: Fractional Flow Reserve Versus Angiography in Multivessel Evaluation 2 Substudy.

Détails

ID Serval
serval:BIB_B9685309EC3B
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Angiography Versus Hemodynamics to Predict the Natural History of Coronary Stenoses: Fractional Flow Reserve Versus Angiography in Multivessel Evaluation 2 Substudy.
Périodique
Circulation
Auteur(s)
Ciccarelli G., Barbato E., Toth G.G., Gahl B., Xaplanteris P., Fournier S., Milkas A., Bartunek J., Vanderheyden M., Pijls N., Tonino P., Fearon W.F., Jüni P., De Bruyne B.
ISSN
1524-4539 (Electronic)
ISSN-L
0009-7322
Statut éditorial
Publié
Date de publication
03/04/2018
Peer-reviewed
Oui
Volume
137
Numéro
14
Pages
1475-1485
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
Among patients with documented stable coronary artery disease and in whom no revascularization was performed, we compared the respective values of angiographic diameter stenosis (DS) and fractional flow reserve (FFR) in predicting natural history.
The present analysis included the 607 patients from the FAME 2 trial (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation 2) in whom no revascularization was performed. FFR varied from 0.20 to 1.00 (average 0.74±0.16), and DS (by quantitative coronary analysis) varied from 8% to 98% (average 53±15). The primary end point, defined as vessel-oriented clinical end point (VOCE) at 2 years, was a composite of prospectively adjudicated cardiac death, vessel-related myocardial infarction, vessel-related urgent, and not urgent revascularization. The stenoses were divided into 4 groups according to FFR and %DS values: positive concordance (FFR≤0.80; DS≥50%), negative concordance (FFR>0.80; DS<50%), positive mismatch (FFR≤0.80; DS<50%), and negative mismatch (FFR>0.80; DS≥50%).
The rate of VOCE was highest in the positive concordance group (log rank: X <sup>2</sup> =80.96; <i>P</i> =0.001) and lowest in the negative concordance group. The rate of VOCE was higher in the positive mismatch group than in the negative mismatch group (hazard ratio, 0.38; 95% confidence interval, 0.21-0.67; <i>P</i> =0.001). There was no significant difference in VOCE between the positive concordance and positive mismatch groups (FFR≤0.80; hazard ratio, 0.77; 95% confidence interval, 0.57-1.09; <i>P</i> =0.149) and no significant difference in rate of VOCE between the negative mismatch and negative concordance groups (FFR>0.80; hazard ratio, 1.89; 95% confidence interval, 0.96-3.74; <i>P</i> =0.067).
In patients with stable coronary disease, physiology (FFR) is a more important determinant of the natural history of coronary stenoses than anatomy (DS).
URL: https://clinicaltrials.gov. Unique identifier: NCT01132495.
Mots-clé
angiography, coronary artery disease, fractional flow reserve, percutaneous coronary intervention
Pubmed
Web of science
Création de la notice
09/05/2018 13:49
Dernière modification de la notice
20/08/2019 16:27
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