المؤلفون: Yuhei Kobayashi^1,2, Chang-Wook Nam³, Tonino, Pirn A. L.⁴, Takumi Kimura^1,2, De Bruyne, Bernard⁵, Pijls, Nico H. J.⁴, Fearon, William F.^1,2 wfearon@stanford.edu, Kobayashi, Yuhei⁶ (AUTHOR), Nam, Chang-Wook³ (AUTHOR), Tonino, Pim A L⁴ (AUTHOR), Kimura, Takumi⁶ (AUTHOR), FAME Study Investigators (CORPORATE AUTHOR)

المصدر: Journal of the American College of Cardiology (JACC). 4/12/2016, Vol. 67 Issue 14, p1701-1711. 11p.

مصطلحات موضوعية: *CORONARY artery stenosis, *PSYCHOLOGICAL tests, *REVASCULARIZATION (Surgery), *ISCHEMIA, *PATIENTS, *CORONARY heart disease treatment, *CARDIOVASCULAR system, *COMPARATIVE studies, *CORONARY circulation, *CORONARY disease, *LONGITUDINAL method, *RESEARCH methodology, *MEDICAL care, *MEDICAL cooperation, *MYOCARDIAL infarction, *PROGNOSIS, *REOPERATION, *RESEARCH, *EVALUATION research, *RANDOMIZED controlled trials, *CORONARY angiography, *THERAPEUTICS

مستخلص: Background: The residual SYNTAX score (RSS) and SYNTAX revascularization index (SRI) quantitatively assess angiographic completeness of revascularization for patients with multivessel coronary artery disease. Whether residual angiographic disease remains of prognostic importance after "functionally" complete revascularization with fractional flow reserve (FFR) guidance is unknown.Objectives: This study sought to investigate the prognostic value of the RSS and SRI after FFR-guided functionally complete revascularization.Methods: From the FFR-guided percutaneous coronary intervention (PCI) cohort of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) trial, the RSS and SRI were calculated in 427 patients after functionally complete revascularization. The RSS was defined as the SYNTAX score (SS) recalculated after PCI. The SRI was calculated as: 100 × (1 - RSS/baseline SS) (%). We compared differences in 1- and 2-year outcomes among patients with RSS of 0, >0 to 4, >4 to 8, and >8, and with SRI of 100%, 50% to <100%, and 0 to <50%.Results: The mean baseline SS, RSS, and SRI were 14.4 ± 7.2, 6.5 ± 5.8, and 55.1 ± 32.5%, respectively. Major adverse cardiac events (MACE) at 1 year occurred in 53 patients (12.4%). Patients with MACE had higher SS than those without (18.0 [interquartile range (IQR): 11.0 to 21.0] vs. 12.0 [IQR: 9.0 to 18.0], p = 0.001), but had similar RSS and SRI after PCI (RSS: 6.0 [IQR: 3.0 to 10.0] vs. 5.0 [IQR: 2.0 to 9.5], p = 0.51 and SRI: 60.0% [IQR: 40.9% to 78.9%] vs. 58.8% [IQR: 26.7% to 81.8%], p = 0.24, respectively). Kaplan-Meier analysis showed similar 1-year incidence of MACE with RSS/SRI stratifications (log-rank p = 0.55 and p = 0.54, respectively). Results were similar with 2-year outcome data analysis.Conclusions: After functionally complete revascularization with FFR guidance, residual angiographic lesions that are not functionally significant do not reflect residual ischemia or predict a worse outcome, supporting functionally complete, rather than angiographically complete, revascularization. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [FAME]; NCT00267774). [ABSTRACT FROM AUTHOR]

المؤلفون: Tonino PA (AUTHOR), Fearon WF (AUTHOR), De Bruyne B (AUTHOR), Oldroyd KG (AUTHOR), Leesar MA (AUTHOR), Ver Lee PN (AUTHOR), Maccarthy PA (AUTHOR), Van't Veer M (AUTHOR), Pijls NH (AUTHOR), Tonino, Pim A L¹ (AUTHOR), Fearon, William F (AUTHOR), De Bruyne, Bernard (AUTHOR), Oldroyd, Keith G (AUTHOR), Leesar, Massoud A (AUTHOR), Ver Lee, Peter N (AUTHOR), Maccarthy, Philip A (AUTHOR), Van't Veer, Marcel (AUTHOR), Pijls, Nico H J (AUTHOR)

المصدر: Journal of the American College of Cardiology (JACC). Jun2010, Vol. 55 Issue 25, p2816-2821. 6p.

مستخلص: Objectives: The purpose of this study was to investigate the relationship between angiographic and functional severity of coronary artery stenoses in the FAME (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation) study. Background: It can be difficult to determine on the coronary angiogram which lesions cause ischemia. Revascularization of coronary stenoses that induce ischemia improves a patient's functional status and outcome. For stenoses that do not induce ischemia, however, the benefit of revascularization is less clear. Methods: In the FAME study, routine measurement of the fractional flow reserve (FFR) was compared with angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease. The use of the FFR in addition to angiography significantly reduced the rate of all major adverse cardiac events at 1 year. Of the 1,414 lesions (509 patients) in the FFR-guided arm of the FAME study, 1,329 were successfully assessed by the FFR and are included in this analysis. Results: Before FFR measurement, these lesions were categorized into 50% to 70% (47% of all lesions), 71% to 90% (39% of all lesions), and 91% to 99% (15% of all lesions) diameter stenosis by visual assessment. In the category 50% to 70% stenosis, 35% were functionally significant (FFR 0.80). In the category 71% to 90% stenosis, 80% were functionally significant and 20% were not. In the category of subtotal stenoses, 96% were functionally significant. Of all 509 patients with angiographically defined multivessel disease, only 235 (46%) had functional multivessel disease (>or=2 coronary arteries with an FFR Conclusions: Angiography is inaccurate in assessing the functional significance of a coronary stenosis when compared with the FFR, not only in the 50% to 70% category but also in the 70% to 90% angiographic severity category. [ABSTRACT FROM AUTHOR]