Author + information
- Received August 2, 2017
- Revision received September 6, 2017
- Accepted September 13, 2017
- Published online February 5, 2018.
- Ki Hong Choi, MDa,
- Joo Myung Lee, MD, MPH, PhDa,
- Bon-Kwon Koo, MD, PhDb,c,∗ (, )
- Chang-Wook Nam, MD, PhDd,
- Eun-Seok Shin, MD, PhDe,
- Joon-Hyung Doh, MD, PhDf,
- Tae-Min Rhee, MDb,
- Doyeon Hwang, MDb,
- Jonghanne Park, MDb,
- Jinlong Zhang, MDb,
- Kyung-Jin Kim, MDg,
- Xinyang Hu, MD, PhDh,
- Jianan Wang, MD, PhDh,
- Fei Ye, MD, PhDi,
- Shaoliang Chen, MD, PhDi,
- Junqing Yang, MD, PhDj,
- Jiyan Chen, MD, PhDj,
- Nobuhiro Tanaka, MD, PhDk,
- Hiroyoshi Yokoi, MD, PhDl,
- Hitoshi Matsuo, MD, PhDm,
- Hiroaki Takashima, MD, PhDn,
- Yasutsugu Shiono, MD, PhDo and
- Takashi Akasaka, MD, PhDo
- aDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
- bDepartment of Internal Medicine and Cardiovascular Center; Seoul National University, Seoul, Korea
- cInstitute on Aging, Seoul National University, Seoul, Korea
- dDivision of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
- eDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- fDepartment of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
- gDivision of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
- hDepartment of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- iDepartment of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- jGuangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- kDepartment of Cardiology, Tokyo Medical University, Tokyo, Japan
- lKokura Memorial Hospital, Kitakyuku, Japan
- mDepartment of Cardiology, Gifu Heart Center, Gifu, Japan
- nDepartment of Cardiology, Aichi Medical University, Nagakute, Japan
- oWakayama Medical University, Wakayama, Japan
- ↵∗Address for correspondence:
Dr. Bon-Kwon Koo, Seoul National University Hospital, Department of Internal Medicine and Cardiovascular Center, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Korea.
Objectives The aim of this study was to investigate the prognostic implication of functional incomplete revascularization (IR) and residual functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (rFSS) in comparison with 3-vessel fractional flow reserve (FFR) and residual SYNTAX score.
Background IR is associated with poor clinical outcomes in patients who underwent percutaneous coronary intervention.
Methods A total of 385 patients who underwent 3-vessel FFR measurement after stent implantation were included in this study. The rFSS was defined as residual SYNTAX score measured only in vessels with FFR ≤0.8. The study population was divided into the functional IR group (rFSS ≥1) and the functional complete revascularization (CR) group (rFSS = 0). The primary outcome was major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization) at 2 years.
Results Functional CR was achieved in 283 patients (73.5%). At 2-year follow-up, the functional IR group showed a significantly higher risk for MACEs (functional IR vs. CR, 14.6% vs. 4.2%; hazard ratio: 4.09; 95% confidence interval: 1.82 to 9.21; p < 0.001) than the functional CR group. In a multivariate-adjusted model, functional IR was an independent predictor of MACEs (adjusted hazard ratio: 4.17; 95% confidence interval: 1.85 to 9.44; p < 0.001). The rFSS showed a significant association with estimated 2-year MACE rate (hazard ratio: 1.09 per 1-U increase; 95% confidence interval: 1.02 to 1.17; p = 0.018). When added to clinical risk factors, rFSS showed the highest integrated discrimination improvement value for MACEs (3.5%; p = 0.002) among 3-vessel FFR, residual SYNTAX score, and rFSS.
Conclusions Patients with functional IR showed significantly higher rate of 2-year MACEs than those with functional CR. A combined anatomic and physiological scoring system (rFSS) after stent implantation better discriminated the risk for adverse events than anatomic or physiological assessment alone. (Clinical Implication of 3-Vessel Fractional Flow Reserve [FFR]; NCT01621438)
- coronary artery disease
- fractional flow reserve
- functional SYNTAX score
- percutaneous coronary intervention
- SYNTAX score
This study was supported by an unrestricted research grant from Abbott. The company had no role in study design, conduct, data analysis, or manuscript preparation. Dr. Koo has received an institutional research grant from Abbott. All other authors have reported that they have no relationships relevant to contents of this paper to disclose. Drs. Choi and Lee contributed equally to this work.
- Received August 2, 2017.
- Revision received September 6, 2017.
- Accepted September 13, 2017.
- 2018 American College of Cardiology Foundation