Author + information
- Received February 12, 2020
- Accepted February 25, 2020
- Published online July 20, 2020.
- Takayuki Warisawa, MDa,b,
- Christopher M. Cook, MBBS, BSca,c,
- Christopher Rajkumar, MBBS, BSca,c,
- James P. Howard, MB BCHIRa,c,
- Henry Seligman, BA, MBBSa,c,
- Yousif Ahmad, BMBSa,c,
- Stephanie El Hajj, MDd,
- Shunichi Doi, MDe,
- Akihiro Nakajima, MDf,
- Masafumi Nakayama, MD, PhDg,h,
- Sonoka Goto, MDi,j,
- Rafael Vera-Urquiza, MDi,
- Takao Sato, MDj,
- Yuetsu Kikuta, MDa,k,
- Yoshiaki Kawase, MDl,
- Hidetaka Nishina, MDm,
- Ricardo Petraco, MD, PhDa,c,
- Rasha Al-Lamee, MD, PhDa,c,
- Sukhjinder Nijjer, MD, PhDa,c,
- Sayan Sen, MD, PhDa,c,
- Sunao Nakamura, MD, PhDf,
- Amir Lerman, MD, PhDd,
- Hitoshi Matsuo, MD, PhDl,
- Darrel P. Francis, MD, PhDa,c,
- Yoshihiro J. Akashi, MD, PhDe,
- Javier Escaned, MD, PhDi and
- Justin E. Davies, MD, PhDc,∗ ()
- aNational Heart and Lung Institute, Imperial College London, London, United Kingdom
- bDepartment of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
- cCardiovascular Science, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- dDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- eDivision of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- fDepartment of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
- gCardiovascular Center, Toda Central General Hospital, Toda, Japan
- hTokyo Women’s Medical University–Waseda University Joint Institution for Advanced Biomedical Sciences, Tokyo, Japan
- iCardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
- jDepartment of Cardiology, Tachikawa General Hospital, Nagaoka, Japan
- kDivision of Cardiology, Fukuyama Cardiovascular Hospital, Fukuyama, Japan
- lDepartment of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
- mDepartment of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
- ↵∗Address for correspondence:
Dr. Justin E. Davies, Hammersmith Hospital, Imperial College Healthcare NHS Trust, B Block South, 2nd Floor, NHLI–Cardiovascular Science, Du Cane Road, London W12 0NN, United Kingdom.
Objectives The aim of this study was to assess the long-term clinical outcomes of patients with left main coronary artery (LM) stenosis in whom treatment strategy was based on the instantaneous wave-free ratio (iFR).
Background The overall safety of iFR to guide revascularization decision making in patients with stable coronary artery disease has been established. However, no study has examined the safety of deferral of revascularization of LM disease on the basis of iFR.
Methods This multicenter observational study included 314 patients in whom LM stenosis was deferred (n = 163 [51.9%]) or revascularized (n = 151 [48.1%]) according to the iFR cutoff ≤0.89. The primary endpoint was a composite of all-cause death, nonfatal myocardial infarction, and ischemia-driven target lesion revascularization. The secondary endpoints were each individual component of the primary endpoint and also cardiac death.
Results At a median follow-up period of 30 months, the primary endpoint occurred in 15 patients (9.2%) in the deferred group and 22 patients (14.6%) in the revascularized group (hazard ratio: 1.45; 95% confidence interval: 0.75 to 2.81; p = 0.26), indicating no evidence of a significant difference between the 2 groups. For the secondary endpoints, findings in the iFR-based deferral and revascularization groups were as follows: all-cause death, 3.7% versus 4.6%; cardiac death, 1.2% versus 2.0%; nonfatal myocardial infarction, 2.5% versus 5.3%; and target lesion revascularization, 4.3% versus 5.3% (p > 0.05 for all).
Conclusions Deferral of revascularization of LM stenosis on the basis of iFR appears to be safe, with similar long-term outcomes to those in patients in whom LM revascularization was performed according to iFR values.
Dr. Warisawa has received consulting fees from Abbott Vascular and Philips. Dr. Cook has received speaker’s honoraria from Philips Volcano. Dr. Seligman has received a research grant from Amgen. Dr. Howard is supported by the Wellcome Trust (212183/Z/18/Z). Dr. Kikuta has received speaking fees from Abbott Vascular and Philips. Drs. Ahmad and Sen are supported by the Academy of Medical Sciences and Imperial Biomedical Research Centre. Dr. Sen is supported by the Medical Research Council (G1000357); has served on the Speakers Bureaus and participated in educational events for Pfizer, Phillips, Daiichi-Sankyo, and AstraZeneca; and has received speaking fees from Volcano, Pfizer, and Medtronic. Dr. Al-Lamee has received a speaking honorarium from Philips Volcano. Dr. Petraco has served as a consultant for and received speaking fees from Philips Volcano; and is supported by the British Heart Foundation (FS/11/46/28861). Dr. Nijjer has received travel support and speaking fees from Philips Volcano. Dr. Davies holds patents pertaining to the iFR technology; is a consultant for Philips Volcano; and has received research grants from Philips Volcano. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received February 12, 2020.
- Accepted February 25, 2020.
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