Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes.

Détails

ID Serval
serval:BIB_94376A313D80
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes.
Périodique
Journal of the American College of Cardiology
Auteur(s)
Johnson N.P., Tóth G.G., Lai D., Zhu H., Açar G., Agostoni P., Appelman Y., Arslan F., Barbato E., Chen S.L., Di Serafino L., Domínguez-Franco A.J., Dupouy P., Esen A.M., Esen O.B., Hamilos M., Iwasaki K., Jensen L.O., Jiménez-Navarro M.F., Katritsis D.G., Kocaman S.A., Koo B.K., López-Palop R., Lorin J.D., Miller L.H., Muller O., Nam C.W., Oud N., Puymirat E., Rieber J., Rioufol G., Rodés-Cabau J., Sedlis S.P., Takeishi Y., Tonino P.A., Van Belle E., Verna E., Werner G.S., Fearon W.F., Pijls N.H., De Bruyne B., Gould K.L.
ISSN
1558-3597 (Electronic)
ISSN-L
0735-1097
Statut éditorial
Publié
Date de publication
2014
Volume
64
Numéro
16
Pages
1641-1654
Langue
anglais
Notes
Publication types: Journal ArticlePublication Status: ppublish, pdf : Original Investigation
Résumé
BACKGROUND: Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear.
OBJECTIVES: The study hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization.
METHODS: Meta-analysis of study- and patient-level data investigated prognosis after FFR measurement. An interaction term between FFR and revascularization status allowed for an outcomes-based threshold.
RESULTS: A total of 9,173 (study-level) and 6,961 (patient-level) lesions were included with a median follow-up of 16 and 14 months, respectively. Clinical events increased as FFR decreased, and revascularization showed larger net benefit for lower baseline FFR values. Outcomes-derived FFR thresholds generally occurred around the range 0.75 to 0.80, although limited due to confounding by indication. FFR measured immediately after stenting also showed an inverse relationship with prognosis (hazard ratio: 0.86, 95% confidence interval: 0.80 to 0.93; p < 0.001). An FFR-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief.
CONCLUSIONS: FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy.
Pubmed
Web of science
Open Access
Oui
Création de la notice
22/11/2014 10:50
Dernière modification de la notice
08/05/2019 22:13
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