Author + information
- Received March 5, 2018
- Revision received April 30, 2018
- Accepted May 1, 2018
- Published online August 6, 2018.
- Joo Myung Lee, MD, MPH, PhDa,∗,
- Ki Hong Choi, MDa,∗,
- Doyeon Hwang, MDb,
- Jonghanne Park, MD, PhDb,c,
- Ji-Hyun Jung, MDd,
- Hyung Yoon Kim, MDe,
- Hae Won Jung, MDf,
- Yun-Kyeong Cho, MD, PhDg,
- Hyuck-Jun Yoon, MD, PhDg,
- Young Bin Song, MD, PhDa,
- Joo-Yong Hahn, MD, PhDa,
- Joon-Hyung Doh, MD, PhDh,
- Chang-Wook Nam, MD, PhDg,
- Eun-Seok Shin, MD, PhDi,j,
- Seung-Ho Hur, MD, PhDg and
- Bon-Kwon Koo, MD, PhDb,k,∗ ()
- aDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- bDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
- cDepartment of Internal Medicine, Naju National Hospital, Ministry of Health and Welfare, Naju, Republic of Korea
- dSejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea
- eDepartment of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- fDepartment of Cardiology, Daegu Catholic University Medical Center, Daegu, Republic of Korea
- gDepartment of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
- hDepartment of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
- iDivision of Cardiology, Dietrich Bonhoeffer Hospital, Academic Teaching Hospital of University of Greifswald, Greifswald, Germany
- jDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
- kInstitute on Aging, Seoul National University, Seoul, Republic of Korea
- ↵∗Address for correspondence:
Dr. Bon-Kwon Koo, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Republic of Korea.
Objectives This study investigated the prognostic implication of coronary flow reserve (CFR) in patients who underwent fractional flow reserve (FFR) measurement.
Background Limited data are available regarding the long-term prognosis associated with thermodilution CFR in patients with coronary artery disease.
Methods A total of 519 patients (737 vessels) who did not undergo revascularization were classified according to FFR and CFR values. Low FFR and low CFR were defined with upper thresholds of 0.8 and 2.0, respectively. FFR and CFR were measured by a pressure-temperature sensor–tipped wire. Clinical outcomes were assessed by the vessel-oriented composite outcome (VOCO) (a composite of cardiac death, vessel-specific myocardial infarction, and vessel-specific revascularization) during 5 years of follow-up.
Results The categorical agreement (kappa = 0.080; p = 0.024) between FFR and CFR were modest, and 30.6% of the population showed discordant results between FFR and CFR. During 5 years of follow-up, patients with low CFR had a significantly higher risk of VOCO than did those with high CFR (hazard ratio [HR]: 3.171; 95% CI: 1.664 to 6.042; p < 0.001). Among patients with high FFR, there were no differences in clinical risk factor profiles, FFR, or stenosis severity between the high-CFR and low-CFR groups, and low CFR was an independent predictor for VOCO (HR: 4.999; 95% CI: 2.104 to 11.879; p < 0.001). In a 4-group classification according to both FFR and CFR, patients with low FFR and low CFR had the highest risk of VOCO (17.9%; overall p < 0.001).
Conclusions Patients with low CFR had a significantly higher risk of clinical events during 5 years of follow-up. Low CFR was an independent predictor for patient-oriented composite outcome among patients with high FFR. These results support the value of CFR in patients who undergo FFR measurement. (Clinical, Physical and Prognostic Implication of Microvascular Status; NCT02186093)
- coronary artery disease
- coronary flow reserve
- fractional flow reserve
- myocardial ischemia
- percutaneous coronary intervention
↵∗ Drs. Lee and Choi contributed equally to this work
Dr. Lee has received research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Koo has received institutional research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Hahn has received research grant support from St. Jude Medical (Abbott Vascular). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 5, 2018.
- Revision received April 30, 2018.
- Accepted May 1, 2018.
- 2018 American College of Cardiology Foundation
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