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Long-term Patient Prognostication by Coronary Flow Reserve and Index of Microcirculatory Resistance: International Registry of Comprehensive Physiologic Assessment

Korean Circulation Journal 2020년 50권 10호 p.890 ~ 903
이주명, 최기홍, 도준형, 남창욱, 신은석, Hoshino Masahiro, Murai Tadashi, Yonetsu Taishi, Mejia-Renteria Hernan, Kakuta Tsunekazu, Escaned Javier, 구본권,
소속 상세정보
이주명 ( Lee Joo-Myung ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Internal Medicine
최기홍 ( Choi Ki-Hong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Internal Medicine
도준형 ( Doh Joon-Hyung ) - Inje University Ilsan Paik Hospital Department of Medicine
남창욱 ( Nam Chang-Wook ) - Keimyung University Dongsan Medical Center Department of Medicine
신은석 ( Shin Eun-Seok ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Cardiology
 ( Hoshino Masahiro ) - Tsuchiura Kyodo General Hospital Department of Cardiovascular Medicine
 ( Murai Tadashi ) - Tsuchiura Kyodo General Hospital Department of Cardiovascular Medicine
 ( Yonetsu Taishi ) - Tokyo Medical and Dental University Department of Cardiovascular Medicine
 ( Mejia-Renteria Hernan ) - Hospital Clinico San Carlos Cardiovascular Institute
 ( Kakuta Tsunekazu ) - Tsuchiura Kyodo General Hospital Department of Cardiovascular Medicine
 ( Escaned Javier ) - Hospital Clinico San Carlos Cardiovascular Institute
구본권 ( Koo Bon-Kwon ) - Seoul National University Hospital Department of Internal Medicine

Abstract


Background and Objectives: Recent guideline recommends evaluation using of coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients with functionally insignificant stenosis. We evaluated clinical implications of CFR and IMR in patients with high fractional flow reserve (FFR) and deferred revascularization.

Methods: A total of 867 patients (1,152 vessels) consigned to deferred revascularization who underwent comprehensive physiologic assessments were enrolled. Patients with high FFR (>0.80) were categorized by CFR (≤2) and IMR (≥23 U). Clinical outcome was assessed by patient-oriented composite outcome (POCO), a composite of any death, myocardial infarction (MI), and revascularization at 5 years.

Results: Patients with low CFR (≤2) showed significantly greater risk of POCO than those with high CFR (>2) in both high-FFR (p=0.024) and low-FFR (p=0.034) groups. In patients with high FFR, those with low CFR and high IMR (overt microvascular disease) displayed the greatest risk of POCO overall (p=0.015), surpassing those with high CFR and low IMR (HR, 2.873; 95% CI, 1.476?5.594; p=0.002) and showing significantly greater risk of cardiac death or MI (HR, 5.662; 95% CI, 1.984?16.154; p=0.001). Overt microvascular disease was independently associated with POCO in the high-FFR population (HR, 2.282; 95% CI, 1.176?4.429; p=0.015).

Conclusion: Among patients with deferred revascularization, those with low CFR showed significantly greater risk of POCO than those with high CFR, regardless of FFR. In patients with high FFR, those with overt microvascular disease showed significantly greater risk of POCO and cardiac death or MI at 5-year, compared with the others.

키워드

Myocardial ischemia; Coronary artery disease; Fractional flow reserve; Coronary flow reserve; Index of microcirculatory resistance; Percutaneous coronary intervention

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