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A Prospective Natural History Study of Coronary Atherosclerosis Using Fractional Flow Reserve
Abstract Background In patients with coronary artery disease, clinical outcome depends on the extent of reversible myocardial ischemia. Whether the outcome also depends on the severity of the stenosis as determined by fractional flow reserve (FFR) remains unknown. Objectives This study sought to inv...
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| Published in: | Journal of the American College of Cardiology 2016-11, Vol.68 (21), p.2247-2255 |
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| creator | Barbato, Emanuele, MD, PhD Toth, Gabor G., MD Johnson, Nils P., MD Pijls, Nico H.J., MD, PhD Fearon, William F., MD Tonino, Pim A.L., MD, PhD Curzen, Nick, BM, PhD Piroth, Zsolt, MD Rioufol, Gilles, MD, PhD Jüni, Peter, MD De Bruyne, Bernard, MD, PhD |
| description | Abstract Background In patients with coronary artery disease, clinical outcome depends on the extent of reversible myocardial ischemia. Whether the outcome also depends on the severity of the stenosis as determined by fractional flow reserve (FFR) remains unknown. Objectives This study sought to investigate the relationship between FFR values and vessel-related clinical outcome. Methods We prospectively studied major adverse cardiovascular events (MACE) at 2 years in 607 patients in whom all stenoses were assessed by FFR and who were treated with medical therapy alone. The relationship between FFR and 2-year MACE was assessed as a continuous function. Logistic and Cox proportional hazards regression models were used to calculate the average decrease in the risk of MACE per 0.05-U increase in FFR. Results MACE occurred in 272 (26.5%) of 1,029 lesions. Target lesions with diameter stenosis ≥70% were more often present in the MACE group (p < 0.01). Median FFR was significantly lower in the MACE group versus the non-MACE group (0.68 [interquartile range: 0.54 to 0.77] vs. 0.80 [interquartile range: 0.70 to 0.88]; p < 0.01). The cumulative incidence of MACE significantly increased with increasing FFR quartiles. An average decrease in MACE per 0.05-unit increase in FFR was statistically significant even after adjustment for all clinical and angiographic features (odds ratio: 0.81; 95% confidence interval: 0.76 to 0.86]). The strongest increase in MACE occurred for FFR values between 0.80 and 0.60. In multivariable Cox regression analysis, FFR was significantly associated with MACE up to 2 years (hazard ratio: 0.87; 95% confidence interval: 0.83 to 0.91]). Conclusions In patients with stable coronary disease, stenosis severity as assessed by FFR is a major and independent predictor of lesion-related outcome. (FAME II - Fractional Flow Reserve [FFR] Guided Percutaneous Coronary Intervention [PCI] Plus Optimal Medical Treatment [OMT] Verses OMT; NCT01132495 ) |
| doi_str_mv | 10.1016/j.jacc.2016.08.055 |
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Whether the outcome also depends on the severity of the stenosis as determined by fractional flow reserve (FFR) remains unknown. Objectives This study sought to investigate the relationship between FFR values and vessel-related clinical outcome. Methods We prospectively studied major adverse cardiovascular events (MACE) at 2 years in 607 patients in whom all stenoses were assessed by FFR and who were treated with medical therapy alone. The relationship between FFR and 2-year MACE was assessed as a continuous function. Logistic and Cox proportional hazards regression models were used to calculate the average decrease in the risk of MACE per 0.05-U increase in FFR. Results MACE occurred in 272 (26.5%) of 1,029 lesions. Target lesions with diameter stenosis ≥70% were more often present in the MACE group (p < 0.01). Median FFR was significantly lower in the MACE group versus the non-MACE group (0.68 [interquartile range: 0.54 to 0.77] vs. 0.80 [interquartile range: 0.70 to 0.88]; p < 0.01). The cumulative incidence of MACE significantly increased with increasing FFR quartiles. An average decrease in MACE per 0.05-unit increase in FFR was statistically significant even after adjustment for all clinical and angiographic features (odds ratio: 0.81; 95% confidence interval: 0.76 to 0.86]). The strongest increase in MACE occurred for FFR values between 0.80 and 0.60. In multivariable Cox regression analysis, FFR was significantly associated with MACE up to 2 years (hazard ratio: 0.87; 95% confidence interval: 0.83 to 0.91]). Conclusions In patients with stable coronary disease, stenosis severity as assessed by FFR is a major and independent predictor of lesion-related outcome. (FAME II - Fractional Flow Reserve [FFR] Guided Percutaneous Coronary Intervention [PCI] Plus Optimal Medical Treatment [OMT] Verses OMT; NCT01132495 )</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2016.08.055</identifier><identifier>PMID: 27884241</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Angina pectoris ; Atherosclerosis ; Atherosclerosis - diagnosis ; Atherosclerosis - physiopathology ; Atherosclerosis - surgery ; Cardiology ; Cardiovascular ; Cardiovascular disease ; clinical outcome ; Confidence intervals ; Coronary Angiography ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - physiopathology ; Coronary Artery Disease - surgery ; Coronary vessels ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - physiopathology ; Coronary Vessels - surgery ; Diabetes ; Female ; Follow-Up Studies ; fractional flow reserve ; Fractional Flow Reserve, Myocardial - physiology ; Heart attacks ; Humans ; Internal Medicine ; Ischemia ; Life Sciences ; Male ; Medical imaging ; Middle Aged ; Percutaneous Coronary Intervention - methods ; Prognosis ; Prospective Studies ; Severity of Illness Index ; stable angina ; Stents ; Stratigraphy ; Time Factors ; vessel related</subject><ispartof>Journal of the American College of Cardiology, 2016-11, Vol.68 (21), p.2247-2255</ispartof><rights>American College of Cardiology Foundation</rights><rights>2016 American College of Cardiology Foundation</rights><rights>Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Nov 29, 2016</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c616t-5ce3850f957f63214328abd18bb15893012b629d8edd0e802d9c46060ead6e013</citedby><cites>FETCH-LOGICAL-c616t-5ce3850f957f63214328abd18bb15893012b629d8edd0e802d9c46060ead6e013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,786,790,891,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27884241$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-01850047$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Barbato, Emanuele, MD, PhD</creatorcontrib><creatorcontrib>Toth, Gabor G., MD</creatorcontrib><creatorcontrib>Johnson, Nils P., MD</creatorcontrib><creatorcontrib>Pijls, Nico H.J., MD, PhD</creatorcontrib><creatorcontrib>Fearon, William F., MD</creatorcontrib><creatorcontrib>Tonino, Pim A.L., MD, PhD</creatorcontrib><creatorcontrib>Curzen, Nick, BM, PhD</creatorcontrib><creatorcontrib>Piroth, Zsolt, MD</creatorcontrib><creatorcontrib>Rioufol, Gilles, MD, PhD</creatorcontrib><creatorcontrib>Jüni, Peter, MD</creatorcontrib><creatorcontrib>De Bruyne, Bernard, MD, PhD</creatorcontrib><title>A Prospective Natural History Study of Coronary Atherosclerosis Using Fractional Flow Reserve</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Abstract Background In patients with coronary artery disease, clinical outcome depends on the extent of reversible myocardial ischemia. Whether the outcome also depends on the severity of the stenosis as determined by fractional flow reserve (FFR) remains unknown. Objectives This study sought to investigate the relationship between FFR values and vessel-related clinical outcome. Methods We prospectively studied major adverse cardiovascular events (MACE) at 2 years in 607 patients in whom all stenoses were assessed by FFR and who were treated with medical therapy alone. The relationship between FFR and 2-year MACE was assessed as a continuous function. Logistic and Cox proportional hazards regression models were used to calculate the average decrease in the risk of MACE per 0.05-U increase in FFR. Results MACE occurred in 272 (26.5%) of 1,029 lesions. Target lesions with diameter stenosis ≥70% were more often present in the MACE group (p < 0.01). Median FFR was significantly lower in the MACE group versus the non-MACE group (0.68 [interquartile range: 0.54 to 0.77] vs. 0.80 [interquartile range: 0.70 to 0.88]; p < 0.01). The cumulative incidence of MACE significantly increased with increasing FFR quartiles. An average decrease in MACE per 0.05-unit increase in FFR was statistically significant even after adjustment for all clinical and angiographic features (odds ratio: 0.81; 95% confidence interval: 0.76 to 0.86]). The strongest increase in MACE occurred for FFR values between 0.80 and 0.60. In multivariable Cox regression analysis, FFR was significantly associated with MACE up to 2 years (hazard ratio: 0.87; 95% confidence interval: 0.83 to 0.91]). Conclusions In patients with stable coronary disease, stenosis severity as assessed by FFR is a major and independent predictor of lesion-related outcome. (FAME II - Fractional Flow Reserve [FFR] Guided Percutaneous Coronary Intervention [PCI] Plus Optimal Medical Treatment [OMT] Verses OMT; NCT01132495 )</description><subject>Angina pectoris</subject><subject>Atherosclerosis</subject><subject>Atherosclerosis - diagnosis</subject><subject>Atherosclerosis - physiopathology</subject><subject>Atherosclerosis - surgery</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>clinical outcome</subject><subject>Confidence intervals</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary vessels</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - physiopathology</subject><subject>Coronary Vessels - surgery</subject><subject>Diabetes</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>fractional flow reserve</subject><subject>Fractional Flow Reserve, Myocardial - physiology</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Ischemia</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Percutaneous Coronary Intervention - methods</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Severity of Illness Index</subject><subject>stable angina</subject><subject>Stents</subject><subject>Stratigraphy</subject><subject>Time Factors</subject><subject>vessel related</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqNktGK1DAUhoMo7rj6Al5IwRu9aD1JmzQFEYbBcYRBxXVvDWl66qZ2mjFpR-ZtfBafzNRZV9gL8SYJh-__OTn_IeQxhYwCFS-6rNPGZCy-M5AZcH6HLCjnMs15Vd4lCyhznlKoyjPyIIQOAISk1X1yxkopC1bQBfm8TD54F_ZoRnvA5J0eJ6_7ZGPD6PwxuRin5pi49uePlfNu0LG0HK8wKkw_nzYkl8EOX5K119EhEn2y7t335CMG9Ad8SO61ug_46Po-J5fr159Wm3T7_s3b1XKbGkHFmHKDueTQVrxsRc5okTOp64bKuqZcVjlQVgtWNRKbBlACaypTCBCAuhEIND8nz0--V7pXe293sVPltFWb5VbNNaDRH4ryMLPPTuzeu28ThlHtbDDY93pANwU1k6XktIT_QIsCWCGEiOjTW2jnJh_n8ZsqCxYZGSl2okwcXvDY3jRLQc2hqk7Noao5VAVSxVCj6Mm19VTvsLmR_EkxAi9PAMYRHyx6FYzFwWBjfQxWNc7-2__VLbnp7WCN7r_iEcPff6jAFKiLea3mraIi5zkTMv8F8E7F-w</recordid><startdate>20161129</startdate><enddate>20161129</enddate><creator>Barbato, Emanuele, MD, PhD</creator><creator>Toth, Gabor G., MD</creator><creator>Johnson, Nils P., MD</creator><creator>Pijls, Nico H.J., MD, PhD</creator><creator>Fearon, William F., MD</creator><creator>Tonino, Pim A.L., MD, PhD</creator><creator>Curzen, Nick, BM, PhD</creator><creator>Piroth, Zsolt, MD</creator><creator>Rioufol, Gilles, MD, PhD</creator><creator>Jüni, Peter, MD</creator><creator>De Bruyne, Bernard, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>1XC</scope></search><sort><creationdate>20161129</creationdate><title>A Prospective Natural History Study of Coronary Atherosclerosis Using Fractional Flow Reserve</title><author>Barbato, Emanuele, MD, PhD ; Toth, Gabor G., MD ; Johnson, Nils P., MD ; Pijls, Nico H.J., MD, PhD ; Fearon, William F., MD ; Tonino, Pim A.L., MD, PhD ; Curzen, Nick, BM, PhD ; Piroth, Zsolt, MD ; Rioufol, Gilles, MD, PhD ; Jüni, Peter, MD ; De Bruyne, Bernard, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c616t-5ce3850f957f63214328abd18bb15893012b629d8edd0e802d9c46060ead6e013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Angina pectoris</topic><topic>Atherosclerosis</topic><topic>Atherosclerosis - diagnosis</topic><topic>Atherosclerosis - physiopathology</topic><topic>Atherosclerosis - surgery</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>clinical outcome</topic><topic>Confidence intervals</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary vessels</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - physiopathology</topic><topic>Coronary Vessels - surgery</topic><topic>Diabetes</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>fractional flow reserve</topic><topic>Fractional Flow Reserve, Myocardial - physiology</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Ischemia</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Middle Aged</topic><topic>Percutaneous Coronary Intervention - methods</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Severity of Illness Index</topic><topic>stable angina</topic><topic>Stents</topic><topic>Stratigraphy</topic><topic>Time Factors</topic><topic>vessel related</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barbato, Emanuele, MD, PhD</creatorcontrib><creatorcontrib>Toth, Gabor G., MD</creatorcontrib><creatorcontrib>Johnson, Nils P., MD</creatorcontrib><creatorcontrib>Pijls, Nico H.J., MD, PhD</creatorcontrib><creatorcontrib>Fearon, William F., MD</creatorcontrib><creatorcontrib>Tonino, Pim A.L., MD, PhD</creatorcontrib><creatorcontrib>Curzen, Nick, BM, PhD</creatorcontrib><creatorcontrib>Piroth, Zsolt, MD</creatorcontrib><creatorcontrib>Rioufol, Gilles, MD, PhD</creatorcontrib><creatorcontrib>Jüni, Peter, MD</creatorcontrib><creatorcontrib>De Bruyne, Bernard, MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barbato, Emanuele, MD, PhD</au><au>Toth, Gabor G., MD</au><au>Johnson, Nils P., MD</au><au>Pijls, Nico H.J., MD, PhD</au><au>Fearon, William F., MD</au><au>Tonino, Pim A.L., MD, PhD</au><au>Curzen, Nick, BM, PhD</au><au>Piroth, Zsolt, MD</au><au>Rioufol, Gilles, MD, PhD</au><au>Jüni, Peter, MD</au><au>De Bruyne, Bernard, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Prospective Natural History Study of Coronary Atherosclerosis Using Fractional Flow Reserve</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2016-11-29</date><risdate>2016</risdate><volume>68</volume><issue>21</issue><spage>2247</spage><epage>2255</epage><pages>2247-2255</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-News-2</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><notes>ObjectType-Feature-2</notes><abstract>Abstract Background In patients with coronary artery disease, clinical outcome depends on the extent of reversible myocardial ischemia. Whether the outcome also depends on the severity of the stenosis as determined by fractional flow reserve (FFR) remains unknown. Objectives This study sought to investigate the relationship between FFR values and vessel-related clinical outcome. Methods We prospectively studied major adverse cardiovascular events (MACE) at 2 years in 607 patients in whom all stenoses were assessed by FFR and who were treated with medical therapy alone. The relationship between FFR and 2-year MACE was assessed as a continuous function. Logistic and Cox proportional hazards regression models were used to calculate the average decrease in the risk of MACE per 0.05-U increase in FFR. Results MACE occurred in 272 (26.5%) of 1,029 lesions. Target lesions with diameter stenosis ≥70% were more often present in the MACE group (p < 0.01). Median FFR was significantly lower in the MACE group versus the non-MACE group (0.68 [interquartile range: 0.54 to 0.77] vs. 0.80 [interquartile range: 0.70 to 0.88]; p < 0.01). The cumulative incidence of MACE significantly increased with increasing FFR quartiles. An average decrease in MACE per 0.05-unit increase in FFR was statistically significant even after adjustment for all clinical and angiographic features (odds ratio: 0.81; 95% confidence interval: 0.76 to 0.86]). The strongest increase in MACE occurred for FFR values between 0.80 and 0.60. In multivariable Cox regression analysis, FFR was significantly associated with MACE up to 2 years (hazard ratio: 0.87; 95% confidence interval: 0.83 to 0.91]). Conclusions In patients with stable coronary disease, stenosis severity as assessed by FFR is a major and independent predictor of lesion-related outcome. (FAME II - Fractional Flow Reserve [FFR] Guided Percutaneous Coronary Intervention [PCI] Plus Optimal Medical Treatment [OMT] Verses OMT; NCT01132495 )</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27884241</pmid><doi>10.1016/j.jacc.2016.08.055</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Angina pectoris Atherosclerosis Atherosclerosis - diagnosis Atherosclerosis - physiopathology Atherosclerosis - surgery Cardiology Cardiovascular Cardiovascular disease clinical outcome Confidence intervals Coronary Angiography Coronary Artery Disease - diagnosis Coronary Artery Disease - physiopathology Coronary Artery Disease - surgery Coronary vessels Coronary Vessels - diagnostic imaging Coronary Vessels - physiopathology Coronary Vessels - surgery Diabetes Female Follow-Up Studies fractional flow reserve Fractional Flow Reserve, Myocardial - physiology Heart attacks Humans Internal Medicine Ischemia Life Sciences Male Medical imaging Middle Aged Percutaneous Coronary Intervention - methods Prognosis Prospective Studies Severity of Illness Index stable angina Stents Stratigraphy Time Factors vessel related |
| title | A Prospective Natural History Study of Coronary Atherosclerosis Using Fractional Flow Reserve |
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