Determinants of insufficient improvement in fractional flow reserve following percutaneous coronary intervention
Fractional flow reserve (FFR) has become an increasingly important index for decision making concerning coronary revascularization. It is commonly accepted that significant improvement in FFR following percutaneous coronary intervention (PCI) is associated with better symptomatic relief and a lower...
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| Veröffentlicht in: | Heart and vessels 2020-12, Vol.35 (12), p.1650-1656 |
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| creator | Hirai, Keisuke Kawasaki, Tomohiro Sakakura, Kenichi Soejima, Toshiya Kajiyama, Kimihiro Fukami, Yurie Haraguchi, Kazuki Okonogi, Taichi Fukuoka, Ryota Orita, Yoshiya Umeji, Kyoko Koga, Hisashi Yamabe, Hiroshige |
| description | Fractional flow reserve (FFR) has become an increasingly important index for decision making concerning coronary revascularization. It is commonly accepted that significant improvement in FFR following percutaneous coronary intervention (PCI) is associated with better symptomatic relief and a lower event rate. However, in lesions with insufficient FFR improvement, PCI may not improve prognosis. Leading to the observation that the clinical and angiographic characteristics associated with insufficient FFR improvement have not been fully explored. The purpose of this study was to investigate the factors associated with insufficient improvement in FFR. Using our own PCI database, established between January 2014 and December 2018, we identified 220 stable coronary artery lesions, which had been evaluated for both pre- and post-PCI FFR values. All 220 of these lesions were included in this study. The improvement in FFR (ΔFFR) was calculated in each lesion with the lowest quartile of ΔFFR being defined as the lowest ΔFFR group, and the other quartiles being defined as the intermediate-high ΔFFR group. The mean ΔFFR in the lowest and intermediate-high ΔFFR groups was 0.07 ± 0.02 and 0.21 ± 0.11, respectively. In multivariate logistic regression analysis, a short total stent length (10 mm increase: OR 0.67, 95% CI 0.47–0.96,
P
= 0.030), higher pre-PCI FFR (0.1 increase: OR 4.07, 95% CI 1.83–9.06,
P
= 0.001), in-stent restenosis (ISR) (OR 8.02, 95% CI 1.26–51.09,
P
= 0.028), myocardial infarction (MI) in the target vessel (OR 6.87, 95% CI 1.19–39.69,
P
= 0.031) and non-use of intravascular imaging (OR 0.35, 95% CI 0.12–0.99,
P
= 0.048) were significantly associated with the lowest ΔFFR group. The use of short stents, higher pre-PCI FFR values, ISR, MI in the target vessel, and non-use of intravascular imaging were significantly associated with insufficient FFR improvement. It was conversely suggested that full coverage and adequate dilatation of the lesions under an intravascular imaging guidance might contribute to an improvement in FFR. |
| doi_str_mv | 10.1007/s00380-020-01645-6 |
| format | Article |
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P
= 0.030), higher pre-PCI FFR (0.1 increase: OR 4.07, 95% CI 1.83–9.06,
P
= 0.001), in-stent restenosis (ISR) (OR 8.02, 95% CI 1.26–51.09,
P
= 0.028), myocardial infarction (MI) in the target vessel (OR 6.87, 95% CI 1.19–39.69,
P
= 0.031) and non-use of intravascular imaging (OR 0.35, 95% CI 0.12–0.99,
P
= 0.048) were significantly associated with the lowest ΔFFR group. The use of short stents, higher pre-PCI FFR values, ISR, MI in the target vessel, and non-use of intravascular imaging were significantly associated with insufficient FFR improvement. It was conversely suggested that full coverage and adequate dilatation of the lesions under an intravascular imaging guidance might contribute to an improvement in FFR.</description><identifier>ISSN: 0910-8327</identifier><identifier>EISSN: 1615-2573</identifier><identifier>DOI: 10.1007/s00380-020-01645-6</identifier><identifier>PMID: 32524237</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Aged ; Angioplasty ; Biomedical Engineering and Bioengineering ; Blood vessels ; Cardiac Surgery ; Cardiology ; Coronary Angiography ; Coronary artery ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - physiopathology ; Coronary Artery Disease - therapy ; Databases, Factual ; Decision making ; Drug-Eluting Stents ; Female ; Fractional Flow Reserve, Myocardial ; Humans ; Imaging ; Implants ; Lesions ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Myocardial infarction ; Original Article ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - instrumentation ; Quartiles ; Recovery of Function ; Regression analysis ; Restenosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stents ; Treatment Outcome ; Ultrasonography, Interventional ; Vascular Surgery</subject><ispartof>Heart and vessels, 2020-12, Vol.35 (12), p.1650-1656</ispartof><rights>Springer Japan KK, part of Springer Nature 2020</rights><rights>Springer Japan KK, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c399t-1201f06ce3671fae292e41e77e66b7bf64b3390450c20888b4e090237e8feaf23</citedby><cites>FETCH-LOGICAL-c399t-1201f06ce3671fae292e41e77e66b7bf64b3390450c20888b4e090237e8feaf23</cites><orcidid>0000-0003-2665-9834</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00380-020-01645-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00380-020-01645-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32524237$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hirai, Keisuke</creatorcontrib><creatorcontrib>Kawasaki, Tomohiro</creatorcontrib><creatorcontrib>Sakakura, Kenichi</creatorcontrib><creatorcontrib>Soejima, Toshiya</creatorcontrib><creatorcontrib>Kajiyama, Kimihiro</creatorcontrib><creatorcontrib>Fukami, Yurie</creatorcontrib><creatorcontrib>Haraguchi, Kazuki</creatorcontrib><creatorcontrib>Okonogi, Taichi</creatorcontrib><creatorcontrib>Fukuoka, Ryota</creatorcontrib><creatorcontrib>Orita, Yoshiya</creatorcontrib><creatorcontrib>Umeji, Kyoko</creatorcontrib><creatorcontrib>Koga, Hisashi</creatorcontrib><creatorcontrib>Yamabe, Hiroshige</creatorcontrib><title>Determinants of insufficient improvement in fractional flow reserve following percutaneous coronary intervention</title><title>Heart and vessels</title><addtitle>Heart Vessels</addtitle><addtitle>Heart Vessels</addtitle><description>Fractional flow reserve (FFR) has become an increasingly important index for decision making concerning coronary revascularization. It is commonly accepted that significant improvement in FFR following percutaneous coronary intervention (PCI) is associated with better symptomatic relief and a lower event rate. However, in lesions with insufficient FFR improvement, PCI may not improve prognosis. Leading to the observation that the clinical and angiographic characteristics associated with insufficient FFR improvement have not been fully explored. The purpose of this study was to investigate the factors associated with insufficient improvement in FFR. Using our own PCI database, established between January 2014 and December 2018, we identified 220 stable coronary artery lesions, which had been evaluated for both pre- and post-PCI FFR values. All 220 of these lesions were included in this study. The improvement in FFR (ΔFFR) was calculated in each lesion with the lowest quartile of ΔFFR being defined as the lowest ΔFFR group, and the other quartiles being defined as the intermediate-high ΔFFR group. The mean ΔFFR in the lowest and intermediate-high ΔFFR groups was 0.07 ± 0.02 and 0.21 ± 0.11, respectively. In multivariate logistic regression analysis, a short total stent length (10 mm increase: OR 0.67, 95% CI 0.47–0.96,
P
= 0.030), higher pre-PCI FFR (0.1 increase: OR 4.07, 95% CI 1.83–9.06,
P
= 0.001), in-stent restenosis (ISR) (OR 8.02, 95% CI 1.26–51.09,
P
= 0.028), myocardial infarction (MI) in the target vessel (OR 6.87, 95% CI 1.19–39.69,
P
= 0.031) and non-use of intravascular imaging (OR 0.35, 95% CI 0.12–0.99,
P
= 0.048) were significantly associated with the lowest ΔFFR group. The use of short stents, higher pre-PCI FFR values, ISR, MI in the target vessel, and non-use of intravascular imaging were significantly associated with insufficient FFR improvement. It was conversely suggested that full coverage and adequate dilatation of the lesions under an intravascular imaging guidance might contribute to an improvement in FFR.</description><subject>Aged</subject><subject>Angioplasty</subject><subject>Biomedical Engineering and Bioengineering</subject><subject>Blood vessels</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Coronary Angiography</subject><subject>Coronary artery</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Artery Disease - therapy</subject><subject>Databases, Factual</subject><subject>Decision making</subject><subject>Drug-Eluting Stents</subject><subject>Female</subject><subject>Fractional Flow Reserve, Myocardial</subject><subject>Humans</subject><subject>Imaging</subject><subject>Implants</subject><subject>Lesions</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Myocardial infarction</subject><subject>Original Article</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - instrumentation</subject><subject>Quartiles</subject><subject>Recovery of Function</subject><subject>Regression analysis</subject><subject>Restenosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Stents</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Interventional</subject><subject>Vascular Surgery</subject><issn>0910-8327</issn><issn>1615-2573</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFPHCEYxYmx6a5r_wEPhsRLL9N-wAwMR6OtbbJJL-2ZzOCHwczACjNr-t-XdawmHjwQIPzeg8cj5IzBFwagvmYA0UIFvAwm66aSR2TNJGsq3ihxTNagGVSt4GpFTnK-B2CNZvojWQne8JoLtSa7a5wwjT50Yco0OupDnp3z1mOYqB93Ke5xfFoH6lJnJx9DN1A3xEeaMGPaI3VxKFsf7ugOk52nLmCcM7UxFTb9LdLpwIWD9pR8cN2Q8dPzvCF_vn_7ffWj2v66-Xl1ua2s0HqqGAfmQFoUUjHXIdcca4ZKoZS96p2seyE01A1YDm3b9jWChhIJW4ed42JDPi--JcHDjHkyo88Wh2F5nOE145zpRjcFvXiD3sc5lZQHSpUvroUSheILZVPMOaEzu-THEs8wMIc-zNKHKX2Ypz6MLKLzZ-u5H_H2RfK_gAKIBcjlKNxher37Hdt_CjaXqw</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Hirai, Keisuke</creator><creator>Kawasaki, Tomohiro</creator><creator>Sakakura, Kenichi</creator><creator>Soejima, Toshiya</creator><creator>Kajiyama, Kimihiro</creator><creator>Fukami, Yurie</creator><creator>Haraguchi, Kazuki</creator><creator>Okonogi, Taichi</creator><creator>Fukuoka, Ryota</creator><creator>Orita, Yoshiya</creator><creator>Umeji, Kyoko</creator><creator>Koga, Hisashi</creator><creator>Yamabe, Hiroshige</creator><general>Springer Japan</general><general>Springer Nature B.V</general><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>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2665-9834</orcidid></search><sort><creationdate>20201201</creationdate><title>Determinants of insufficient improvement in fractional flow reserve following percutaneous coronary intervention</title><author>Hirai, Keisuke ; Kawasaki, Tomohiro ; Sakakura, Kenichi ; Soejima, Toshiya ; Kajiyama, Kimihiro ; Fukami, Yurie ; Haraguchi, Kazuki ; Okonogi, Taichi ; Fukuoka, Ryota ; Orita, Yoshiya ; Umeji, Kyoko ; Koga, Hisashi ; Yamabe, Hiroshige</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c399t-1201f06ce3671fae292e41e77e66b7bf64b3390450c20888b4e090237e8feaf23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Angioplasty</topic><topic>Biomedical Engineering and Bioengineering</topic><topic>Blood vessels</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Coronary Angiography</topic><topic>Coronary artery</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Coronary Artery Disease - therapy</topic><topic>Databases, Factual</topic><topic>Decision making</topic><topic>Drug-Eluting Stents</topic><topic>Female</topic><topic>Fractional Flow Reserve, Myocardial</topic><topic>Humans</topic><topic>Imaging</topic><topic>Implants</topic><topic>Lesions</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Myocardial infarction</topic><topic>Original Article</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Percutaneous Coronary Intervention - instrumentation</topic><topic>Quartiles</topic><topic>Recovery of Function</topic><topic>Regression analysis</topic><topic>Restenosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Stents</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Interventional</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hirai, Keisuke</creatorcontrib><creatorcontrib>Kawasaki, Tomohiro</creatorcontrib><creatorcontrib>Sakakura, Kenichi</creatorcontrib><creatorcontrib>Soejima, Toshiya</creatorcontrib><creatorcontrib>Kajiyama, Kimihiro</creatorcontrib><creatorcontrib>Fukami, Yurie</creatorcontrib><creatorcontrib>Haraguchi, Kazuki</creatorcontrib><creatorcontrib>Okonogi, Taichi</creatorcontrib><creatorcontrib>Fukuoka, Ryota</creatorcontrib><creatorcontrib>Orita, Yoshiya</creatorcontrib><creatorcontrib>Umeji, Kyoko</creatorcontrib><creatorcontrib>Koga, Hisashi</creatorcontrib><creatorcontrib>Yamabe, Hiroshige</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Heart and vessels</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hirai, Keisuke</au><au>Kawasaki, Tomohiro</au><au>Sakakura, Kenichi</au><au>Soejima, Toshiya</au><au>Kajiyama, Kimihiro</au><au>Fukami, Yurie</au><au>Haraguchi, Kazuki</au><au>Okonogi, Taichi</au><au>Fukuoka, Ryota</au><au>Orita, Yoshiya</au><au>Umeji, Kyoko</au><au>Koga, Hisashi</au><au>Yamabe, Hiroshige</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Determinants of insufficient improvement in fractional flow reserve following percutaneous coronary intervention</atitle><jtitle>Heart and vessels</jtitle><stitle>Heart Vessels</stitle><addtitle>Heart Vessels</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>35</volume><issue>12</issue><spage>1650</spage><epage>1656</epage><pages>1650-1656</pages><issn>0910-8327</issn><eissn>1615-2573</eissn><abstract>Fractional flow reserve (FFR) has become an increasingly important index for decision making concerning coronary revascularization. It is commonly accepted that significant improvement in FFR following percutaneous coronary intervention (PCI) is associated with better symptomatic relief and a lower event rate. However, in lesions with insufficient FFR improvement, PCI may not improve prognosis. Leading to the observation that the clinical and angiographic characteristics associated with insufficient FFR improvement have not been fully explored. The purpose of this study was to investigate the factors associated with insufficient improvement in FFR. Using our own PCI database, established between January 2014 and December 2018, we identified 220 stable coronary artery lesions, which had been evaluated for both pre- and post-PCI FFR values. All 220 of these lesions were included in this study. The improvement in FFR (ΔFFR) was calculated in each lesion with the lowest quartile of ΔFFR being defined as the lowest ΔFFR group, and the other quartiles being defined as the intermediate-high ΔFFR group. The mean ΔFFR in the lowest and intermediate-high ΔFFR groups was 0.07 ± 0.02 and 0.21 ± 0.11, respectively. In multivariate logistic regression analysis, a short total stent length (10 mm increase: OR 0.67, 95% CI 0.47–0.96,
P
= 0.030), higher pre-PCI FFR (0.1 increase: OR 4.07, 95% CI 1.83–9.06,
P
= 0.001), in-stent restenosis (ISR) (OR 8.02, 95% CI 1.26–51.09,
P
= 0.028), myocardial infarction (MI) in the target vessel (OR 6.87, 95% CI 1.19–39.69,
P
= 0.031) and non-use of intravascular imaging (OR 0.35, 95% CI 0.12–0.99,
P
= 0.048) were significantly associated with the lowest ΔFFR group. The use of short stents, higher pre-PCI FFR values, ISR, MI in the target vessel, and non-use of intravascular imaging were significantly associated with insufficient FFR improvement. It was conversely suggested that full coverage and adequate dilatation of the lesions under an intravascular imaging guidance might contribute to an improvement in FFR.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>32524237</pmid><doi>10.1007/s00380-020-01645-6</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-2665-9834</orcidid></addata></record> |
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| subjects | Aged Angioplasty Biomedical Engineering and Bioengineering Blood vessels Cardiac Surgery Cardiology Coronary Angiography Coronary artery Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - physiopathology Coronary Artery Disease - therapy Databases, Factual Decision making Drug-Eluting Stents Female Fractional Flow Reserve, Myocardial Humans Imaging Implants Lesions Male Medicine Medicine & Public Health Middle Aged Myocardial infarction Original Article Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - instrumentation Quartiles Recovery of Function Regression analysis Restenosis Retrospective Studies Risk Assessment Risk Factors Stents Treatment Outcome Ultrasonography, Interventional Vascular Surgery |
| title | Determinants of insufficient improvement in fractional flow reserve following percutaneous coronary intervention |
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