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Percutaneous Corona...
Percutaneous Coronary Intervention vs Medical Therapy for Coronary Lesions With Positive Fractional Flow Reserve (FFR) but Preserved Pressure-Bounded Coronary Flow Reserve (CFR): A Substudy of the Randomized Compare-Acute Trial
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Haeck, Joost D. E. (author)
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Van't Veer, Marcel (author)
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Zimmermann, Frederik M. (author)
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Neumann, Franz-Josef (author)
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Triantafyllis, Andreas S. (author)
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Sjauw, Krischan D. (author)
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Abdel-Wahab, Mohamed (author)
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- Omerovic, Elmir, 1968 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper,Institute of Clinical Sciences
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Boxma-de Klerk, Bianca M. (author)
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Pijls, Nico H. J. (author)
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Richardt, Gert (author)
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Tonino, Pim A. L. (author)
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Johnson, Nils P. (author)
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Smits, Pieter C. (author)
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(creator_code:org_t)
- 2021
- 2021
- English.
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In: JOURNAL OF INVASIVE CARDIOLOGY. - 1042-3931 .- 1557-2501. ; 33:7
- Related links:
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https://gup.ub.gu.se...
Abstract
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- Objectives. Performing percutaneous coronary intervention (PCI) for fractional flow reserve (FFR) positive coronary lesions improves clinical outcomes and is recommended by international guidelines. It has been hypothesized that lesions with a positive FFR but a preserved coronary flow reserve (CFR) are less likely to be flow limiting and might best be treated medically. We investigated the association of CFR in FFR-positive lesions with clinical outcomes when treated medically, as well as the treatment effect of PCI vs medical therapy in FFR-positive lesions and a preserved CFR. Methods. We performed a substudy of the randomized, multicenter Compare-Acute trial, in which stabilized ST-segment elevation myocardial infarction (STEMI) patients with non-culprit lesions were randomized to either FFR-guided PCI or medical therapy. Based on baseline and hyperemic pressure gradients, we computed physiologic limits of CFR, the so-called pressure-bounded CFR (pb-CFR), and classified lesions as low (<2) or preserved (>= 2). The primary endpoint was 12-month major adverse cardiac and cerebrovascular event (MACCE) rate, defined as a composite of death from any cause, non-fatal myocardial infarction, revascularization, or cerebrovascular events. Results. A total of 980 lesions from 885 patients were included in this substudy. In lesions with FFR <= 0.80, a total of 249 patients had a pb-CFR<2 and 29 patients had a preserved CFR (pb-CFR >= 2). The rate of MACCE at 1 year was not significantly different between patients with FFR <= 0.80 and pb-CFR <2 vs patients with FFR <= 0.80 and pb-CFR >= 2 (25% vs 17%, respectively; P=.39). Because of randomization, baseline characteristics were well balanced between patients with FFR <= 0.80 and pb-CFR >= 2 treated by either by PCI or medical therapy. Importantly, in patients with FFR <= 0.80 and pb-CFR >= 2, MACCE occurred more frequently in patients treated medically vs patients treated by PCI (44% vs 0%, respectively; P=.01). Conclusions. Preserved or low pb-CFR did not alter clinical outcomes in patients with a positive FFR. Patients with FFR-positive coronary lesions but a preserved CFR had more clinical events when treated medically vs those treated with PCI.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
Keyword
- coronary artery disease
- coronary flow reserve
- fractional flow reserve
Publication and Content Type
- ref (subject category)
- art (subject category)
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Haeck, Joost D. ...
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Van't Veer, Marc ...
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Zimmermann, Fred ...
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Neumann, Franz-J ...
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Triantafyllis, A ...
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Sjauw, Krischan ...
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show more...
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Abdel-Wahab, Moh ...
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Omerovic, Elmir, ...
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Boxma-de Klerk, ...
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Pijls, Nico H. J ...
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Richardt, Gert
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Tonino, Pim A. L ...
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Johnson, Nils P.
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Smits, Pieter C.
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show less...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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JOURNAL OF INVAS ...
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University of Gothenburg