Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction

Ki Hong Choi; Woochan Kwon; Doosup Shin; Seung Hun Lee; Doyeon Hwang; Jinlong Zhang; Chang Wook Nam; Eun Seok Shin; Joon Hyung Doh; Shao Liang Chen; Tsunekazu Kakuta; Gabor G. Toth; Zsolt Piroth; Abdul Hakeem; Barry F. Uretsky; Yohei Hokama; Nobuhiro Tanaka; Hong Seok Lim; Tsuyoshi Ito; Akiko Matsuo; Lorenzo Azzalini; Massoud A. Leesar; Joost Daemen; Damien Collison; Carlos Collet; Bernard De Bruyne; Bon Kwon Koo; Taek Kyu Park; Jeong Hoon Yang; Young Bin Song; Joo Yong Hahn; Seung Hyuk Choi; Hyeon Cheol Gwon; Joo Myung Lee

doi:10.1016/j.jacasi.2023.10.009

Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction

Ki Hong Choi, Woochan Kwon, Doosup Shin, Seung Hun Lee, Doyeon Hwang, Jinlong Zhang, Chang Wook Nam, Eun Seok Shin, Joon Hyung Doh, Shao Liang Chen, Tsunekazu Kakuta, Gabor G. Toth, Zsolt Piroth, Abdul Hakeem, Barry F. Uretsky, Yohei Hokama, Nobuhiro Tanaka, Hong Seok Lim, Tsuyoshi Ito, Akiko MatsuoLorenzo Azzalini, Massoud A. Leesar, Joost Daemen, Damien Collison, Carlos Collet, Bernard De Bruyne, Bon Kwon Koo, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Joo Yong Hahn, Seung Hyuk Choi, Hyeon Cheol Gwon, Joo Myung Lee^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

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Abstract

Background:

Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified.

Objectives:

This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF).

Methods:

A total of 2,965 patients with available LVEF were selected from the POST-PCI FLOW (Prognostic Implications of Physiologic Investigation After Revascularization with Stent) international registry of patients with post-PCI FFR measurement. The primary outcome was a composite of cardiac death or target-vessel myocardial infarction (TVMI) at 2 years. The secondary outcome was target-vessel revascularization (TVR) and target vessel failure, which was a composite of cardiac death, TVMI, or TVR.

Results:

Post-PCI FFR was independently associated with the risk of target vessel failure (per 0.01 decrease: HR_adj: 1.029; 95% CI: 1.009-1.049; P = 0.005). Post-PCI FFR was associated with increased risk of cardiac death or TVMI (HR_adj: 1.145; 95% CI: 1.025-1.280; P = 0.017) among patients with LVEF ≤40%, and with that of TVR in patients with LVEF >40% (HR_adj: 1.028; 95% CI: 1.005-1.052; P = 0.020). Post-PCI FFR ≤0.80 was associated with increased risk of cardiac death or TVMI in the LVEF ≤40% group and with that of TVR in LVEF >40% group. Prognostic impact of post-PCI FFR for the primary outcome was significantly different according to LVEF (P_interaction = 0.019).

Conclusions:

Post-PCI FFR had differential prognostic impact according to LVEF. Residual ischemia by post-PCI FFR ≤0.80 was a prognostic indicator for cardiac death or TVMI among patients with patients with LVEF ≤40%, and it was associated with TVR among patients with patients with LVEF>40%.

Original language	English
Pages (from-to)	229-240
Number of pages	12
Journal	JACC: Asia
Volume	4
Issue number	3
Early online date	12 Dec 2023
DOIs	https://doi.org/10.1016/j.jacasi.2023.10.009
Publication status	Published - Mar 2024
Externally published	Yes

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Publisher Copyright:
© 2024 The Authors

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Choi, K. H., Kwon, W., Shin, D., Lee, S. H., Hwang, D., Zhang, J., Nam, C. W., Shin, E. S., Doh, J. H., Chen, S. L., Kakuta, T., Toth, G. G., Piroth, Z., Hakeem, A., Uretsky, B. F., Hokama, Y., Tanaka, N., Lim, H. S., Ito, T., ... Lee, J. M. (2024). Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction. JACC: Asia, 4(3), 229-240. https://doi.org/10.1016/j.jacasi.2023.10.009

@article{537faf4972f9408a9fbb9939a084984d,

title = "Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction",

abstract = "Background: Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified. Objectives: This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF).Methods:A total of 2,965 patients with available LVEF were selected from the POST-PCI FLOW (Prognostic Implications of Physiologic Investigation After Revascularization with Stent) international registry of patients with post-PCI FFR measurement. The primary outcome was a composite of cardiac death or target-vessel myocardial infarction (TVMI) at 2 years. The secondary outcome was target-vessel revascularization (TVR) and target vessel failure, which was a composite of cardiac death, TVMI, or TVR. Results: Post-PCI FFR was independently associated with the risk of target vessel failure (per 0.01 decrease: HRadj: 1.029; 95% CI: 1.009-1.049; P = 0.005). Post-PCI FFR was associated with increased risk of cardiac death or TVMI (HRadj: 1.145; 95% CI: 1.025-1.280; P = 0.017) among patients with LVEF ≤40%, and with that of TVR in patients with LVEF >40% (HRadj: 1.028; 95% CI: 1.005-1.052; P = 0.020). Post-PCI FFR ≤0.80 was associated with increased risk of cardiac death or TVMI in the LVEF ≤40% group and with that of TVR in LVEF >40% group. Prognostic impact of post-PCI FFR for the primary outcome was significantly different according to LVEF (Pinteraction = 0.019).Conclusions: Post-PCI FFR had differential prognostic impact according to LVEF. Residual ischemia by post-PCI FFR ≤0.80 was a prognostic indicator for cardiac death or TVMI among patients with patients with LVEF ≤40%, and it was associated with TVR among patients with patients with LVEF>40%.",

author = "Choi, {Ki Hong} and Woochan Kwon and Doosup Shin and Lee, {Seung Hun} and Doyeon Hwang and Jinlong Zhang and Nam, {Chang Wook} and Shin, {Eun Seok} and Doh, {Joon Hyung} and Chen, {Shao Liang} and Tsunekazu Kakuta and Toth, {Gabor G.} and Zsolt Piroth and Abdul Hakeem and Uretsky, {Barry F.} and Yohei Hokama and Nobuhiro Tanaka and Lim, {Hong Seok} and Tsuyoshi Ito and Akiko Matsuo and Lorenzo Azzalini and Leesar, {Massoud A.} and Joost Daemen and Damien Collison and Carlos Collet and {De Bruyne}, Bernard and Koo, {Bon Kwon} and Park, {Taek Kyu} and Yang, {Jeong Hoon} and Song, {Young Bin} and Hahn, {Joo Yong} and Choi, {Seung Hyuk} and Gwon, {Hyeon Cheol} and Lee, {Joo Myung}",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = mar,

doi = "10.1016/j.jacasi.2023.10.009",

language = "English",

volume = "4",

pages = "229--240",

journal = "JACC: Asia",

issn = "2772-3747",

publisher = "Elsevier Inc.",

number = "3",

}

Choi, KH, Kwon, W, Shin, D, Lee, SH, Hwang, D, Zhang, J, Nam, CW, Shin, ES, Doh, JH, Chen, SL, Kakuta, T, Toth, GG, Piroth, Z, Hakeem, A, Uretsky, BF, Hokama, Y, Tanaka, N, Lim, HS, Ito, T, Matsuo, A, Azzalini, L, Leesar, MA, Daemen, J, Collison, D, Collet, C, De Bruyne, B, Koo, BK, Park, TK, Yang, JH, Song, YB, Hahn, JY, Choi, SH, Gwon, HC & Lee, JM 2024, 'Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction', JACC: Asia, vol. 4, no. 3, pp. 229-240. https://doi.org/10.1016/j.jacasi.2023.10.009

TY - JOUR

T1 - Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction

AU - Choi, Ki Hong

AU - Kwon, Woochan

AU - Shin, Doosup

AU - Lee, Seung Hun

AU - Hwang, Doyeon

AU - Zhang, Jinlong

AU - Nam, Chang Wook

AU - Shin, Eun Seok

AU - Doh, Joon Hyung

AU - Chen, Shao Liang

AU - Kakuta, Tsunekazu

AU - Toth, Gabor G.

AU - Piroth, Zsolt

AU - Hakeem, Abdul

AU - Uretsky, Barry F.

AU - Hokama, Yohei

AU - Tanaka, Nobuhiro

AU - Lim, Hong Seok

AU - Ito, Tsuyoshi

AU - Matsuo, Akiko

AU - Azzalini, Lorenzo

AU - Leesar, Massoud A.

AU - Daemen, Joost

AU - Collison, Damien

AU - Collet, Carlos

AU - De Bruyne, Bernard

AU - Koo, Bon Kwon

AU - Park, Taek Kyu

AU - Yang, Jeong Hoon

AU - Song, Young Bin

AU - Hahn, Joo Yong

AU - Choi, Seung Hyuk

AU - Gwon, Hyeon Cheol

AU - Lee, Joo Myung

PY - 2024/3

Y1 - 2024/3

N2 - Background: Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified. Objectives: This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF).Methods:A total of 2,965 patients with available LVEF were selected from the POST-PCI FLOW (Prognostic Implications of Physiologic Investigation After Revascularization with Stent) international registry of patients with post-PCI FFR measurement. The primary outcome was a composite of cardiac death or target-vessel myocardial infarction (TVMI) at 2 years. The secondary outcome was target-vessel revascularization (TVR) and target vessel failure, which was a composite of cardiac death, TVMI, or TVR. Results: Post-PCI FFR was independently associated with the risk of target vessel failure (per 0.01 decrease: HRadj: 1.029; 95% CI: 1.009-1.049; P = 0.005). Post-PCI FFR was associated with increased risk of cardiac death or TVMI (HRadj: 1.145; 95% CI: 1.025-1.280; P = 0.017) among patients with LVEF ≤40%, and with that of TVR in patients with LVEF >40% (HRadj: 1.028; 95% CI: 1.005-1.052; P = 0.020). Post-PCI FFR ≤0.80 was associated with increased risk of cardiac death or TVMI in the LVEF ≤40% group and with that of TVR in LVEF >40% group. Prognostic impact of post-PCI FFR for the primary outcome was significantly different according to LVEF (Pinteraction = 0.019).Conclusions: Post-PCI FFR had differential prognostic impact according to LVEF. Residual ischemia by post-PCI FFR ≤0.80 was a prognostic indicator for cardiac death or TVMI among patients with patients with LVEF ≤40%, and it was associated with TVR among patients with patients with LVEF>40%.

AB - Background: Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified. Objectives: This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF).Methods:A total of 2,965 patients with available LVEF were selected from the POST-PCI FLOW (Prognostic Implications of Physiologic Investigation After Revascularization with Stent) international registry of patients with post-PCI FFR measurement. The primary outcome was a composite of cardiac death or target-vessel myocardial infarction (TVMI) at 2 years. The secondary outcome was target-vessel revascularization (TVR) and target vessel failure, which was a composite of cardiac death, TVMI, or TVR. Results: Post-PCI FFR was independently associated with the risk of target vessel failure (per 0.01 decrease: HRadj: 1.029; 95% CI: 1.009-1.049; P = 0.005). Post-PCI FFR was associated with increased risk of cardiac death or TVMI (HRadj: 1.145; 95% CI: 1.025-1.280; P = 0.017) among patients with LVEF ≤40%, and with that of TVR in patients with LVEF >40% (HRadj: 1.028; 95% CI: 1.005-1.052; P = 0.020). Post-PCI FFR ≤0.80 was associated with increased risk of cardiac death or TVMI in the LVEF ≤40% group and with that of TVR in LVEF >40% group. Prognostic impact of post-PCI FFR for the primary outcome was significantly different according to LVEF (Pinteraction = 0.019).Conclusions: Post-PCI FFR had differential prognostic impact according to LVEF. Residual ischemia by post-PCI FFR ≤0.80 was a prognostic indicator for cardiac death or TVMI among patients with patients with LVEF ≤40%, and it was associated with TVR among patients with patients with LVEF>40%.

UR - http://www.scopus.com/inward/record.url?scp=85183150388&partnerID=8YFLogxK

U2 - 10.1016/j.jacasi.2023.10.009

DO - 10.1016/j.jacasi.2023.10.009

M3 - Article

C2 - 38463680

AN - SCOPUS:85183150388

SN - 2772-3747

VL - 4

SP - 229

EP - 240

JO - JACC: Asia

JF - JACC: Asia

IS - 3

ER -

Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction

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