Author + information
- Received August 29, 2019
- Revision received March 30, 2020
- Accepted April 1, 2020
- Published online July 20, 2020.
- Ju-Hyun Chung, PhDa,∗,
- Kyung Eun Lee, PhDa,b,∗,
- Joo Myung Lee, MD, MPH, PhDc,
- Ae-Young Her, MD, PhDd,
- Chee Hae Kim, MDe,
- Ki Hong Choi, MDc,
- Young Bin Song, MD, PhDc,
- Joo-Yong Hahn, MD, PhDc,
- Hyung Yoon Kim, MDf,
- Jin-Ho Choi, MD, PhDc,g,
- Scot Garg, MD, PhDh,
- Joon-Hyung Doh, MD, PhDi,
- Chang-Wook Nam, MD, PhDj,
- Bon-Kwon Koo, MD, PhDk and
- Eun-Seok Shin, MD, PhDa,∗ (, )@sesim1989
- aDivision of Cardiology, Department of Internal Medicine, Ulsan Medical Center, Ulsan Hospital, Ulsan, Republic of Korea
- bDepartment of Mechanical Engineering, Inha University, Incheon, Republic of Korea
- cDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- dDivision of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
- eDivision of Cardiology, Department of Internal Medicine, VHS Medical Center, Seoul, Republic of Korea
- fHeart Center, Chonnam National University Hospital, Gwangju, Republic of Korea
- gDepartment of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- hDepartment of Cardiology, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
- iDivision of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
- jDepartment of Internal Medicine, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Republic of Korea
- kDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
- ↵∗Address for correspondence:
Dr. Eun-Seok Shin, Division of Cardiology, Ulsan Hospital, 13, Wolpyeong-ro 171beon-gil, Nam-gu, Ulsan 44686, South Korea.
Objectives This study investigated the sex difference of long-term cardiovascular outcomes on coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients with deferred coronary artery lesions.
Background Coronary microvascular dysfunction is associated with poorer long-term outcomes. It can be assessed by CFR and the IMR.
Methods The study prospectively enrolled 434 patients (133 women and 301 men) and analyzed CFR, IMR, fractional flow reserve, and quantitative coronary angiography. Clinical outcomes were assessed by major adverse cardiovascular event(s) (MACE) of cardiac death, myocardial infarction, and revascularization during 5 years of follow-up. The study protocol was approved by the Institutional Review Board or Ethics Committee at each participating center, and all patients provided written informed consent. The study protocol was in accordance with the Declaration of Helsinki.
Results Women had milder epicardial disease compared with men (fractional flow reserve: 0.91 [interquartile range (IQR): 0.87 to 0.96] vs. 0.90 [IQR: 0.86 to 0.95]; p = 0.037). IMR was similar between the sexes, but CFR was lower in women (2.69 [IQR: 2.08 to 3.90] vs. 3.20 [IQR: 2.20 to 4.31]; p = 0.006) due to a shorter resting mean transit time, whereas hyperemic mean transit times were similar. At 5-year follow-up, MACE was significantly lower in women compared with men (1.1% vs. 5.5%; p = 0.017). Sex, diabetes mellitus, and CFR were independent predictors for MACE for all patients. The risk of MACE was significantly higher in men with low versus high CFR (hazard ratio: 4.58; 95% confidence interval: 1.85 to 11.30; p = 0.011) which was not seen in women.
Conclusions There was no sex difference in microvascular function by IMR. CFR was lower in women due to a higher resting coronary flow; however, long-term clinical outcomes in deferred lesions were better in women compared with men. (Clinical, Physiological and Prognostic Implication of Microvascular Status; NCT02186093).
- coronary artery disease
- coronary flow reserve
- fractional flow reserve
- index of microcirculatory resistance
- microvascular function
↵∗ Drs. Chung and K.E. Lee contributed equally to this work.
This study was supported by an unrestricted research grant from St. Jude Medical and the National Research Foundation of Korea (grant NRF–2018R1D1A1B07044528). Dr. Koo has received institutional research grant support from St. Jude Medical, Abbott, and Philips. 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 August 29, 2019.
- Revision received March 30, 2020.
- Accepted April 1, 2020.
- 2020 American College of Cardiology Foundation
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