Author/Authors :
Johnson، نويسنده , , Nils P. and Tَth، نويسنده , , Gلbor G. and Lai، نويسنده , , Dejian and Zhu، نويسنده , , Hongjian and Açar، نويسنده , , Gِksel and Agostoni، نويسنده , , Pierfrancesco and Appelman، نويسنده , , Yolande and Arslan، نويسنده , , Fatih and Barbato، نويسنده , , Emanuele and Chen، نويسنده , , Shao-Liang and Di Serafino، نويسنده , , Luigi and Domيnguez-Franco، نويسنده , , Antonio J. and Dupouy، نويسنده , , Patrick and Esen، نويسنده , , Ali M. and Esen، نويسنده , , ضzlem B. and Hamilos، نويسنده , , Michalis and Iwasaki، نويسنده , , Kohichiro and Jensen، نويسنده , , Lisette O. and Jiménez-Navarro، نويسنده , , Manuel F. and Katritsis، نويسنده , , Demosthenes G. and Kocaman، نويسنده , , Sinan A. and Koo، نويسنده , , Bon-Kwon and Lَpez-Palop، نويسنده , , Ramَn and Lorin، نويسنده , , Jeffrey D. and Miller، نويسنده , , Louis H. and Muller، نويسنده , , Olivier and Nam، نويسنده , , Chang-Wook and Oud، نويسنده , , Niels and Puymirat، نويسنده , , Etienne and Rieber، نويسنده , , Johannes and Rioufol، نويسنده , , Gilles and Rodés-Cabau، نويسنده , , Josep and Sedlis، نويسنده , , Steven P. and Takeishi، نويسنده , , Yasuchika and Tonino، نويسنده , , Pim A.L. and Van Belle، نويسنده , , Eric and Verna، نويسنده , , Edoardo and Werner، نويسنده , , Gerald S. and Fearon، نويسنده , , William F. and Pijls، نويسنده , , Nico H.J. and De Bruyne، نويسنده , , Bernard and Gould، نويسنده , , K. Lance، نويسنده ,
Abstract :
AbstractBackground
onal flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear.
ives
udy hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization.
s
nalysis of study- and patient-level data investigated prognosis after FFR measurement. An interaction term between FFR and revascularization status allowed for an outcomes-based threshold.
s
l of 9,173 (study-level) and 6,961 (patient-level) lesions were included with a median follow-up of 16 and 14 months, respectively. Clinical events increased as FFR decreased, and revascularization showed larger net benefit for lower baseline FFR values. Outcomes-derived FFR thresholds generally occurred around the range 0.75 to 0.80, although limited due to confounding by indication. FFR measured immediately after stenting also showed an inverse relationship with prognosis (hazard ratio: 0.86, 95% confidence interval: 0.80 to 0.93; p < 0.001). An FFR-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief.
sions
monstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy.
