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Long-term survival in patients with coronary artery disease undergoing percutaneous coronary intervention with or without intracoronary pressure wire guidance : a report from SCAAR
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- Volz, S. (författare)
- Sahlgrenska University Hospital, Gothenburg, Sweden
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- Redfors, B. (författare)
- Sahlgrenska University Hospital, Gothenburg, Sweden
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- Dworeck, C. (författare)
- Sahlgrenska University Hospital, Gothenburg, Sweden
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- Petursson, P. (författare)
- Sahlgrenska University Hospital, Gothenburg, Sweden
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- Gotberg, M. (författare)
- Skåne University Hospital, Lund, Sweden
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- Jernberg, T. (författare)
- Danderyd University Hospital, Stockholm,Sweden
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- Linder, R. (författare)
- Danderyd University Hospital, Stockholm,Sweden
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- Ramunddal, T. (författare)
- Sahlgrenska University Hospital, Gothenburg, Sweden
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- Fröbert, Ole, 1964- (författare)
- Örebro universitet,Institutionen för medicinska vetenskaper
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- Witt, N. (författare)
- South Hospital Stockholm, Stockholm, Sweden
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- James, S. (författare)
- Uppsala University Hospital, Uppsala, Sweden
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- Erlinge, D. (författare)
- Skåne University Hospital, Lund, Sweden
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- Omerovic, E. (författare)
- Sahlgrenska University Hospital, Gothenburg, Sweden
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(creator_code:org_t)
- 2020-11-25
- 2020
- Engelska.
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 41:Suppl. 2, s. 2507-2507
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Background: Intracoronary pressure wire measurements of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) provide decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the impact of FFR/iFR on long-term clinical outcomes in patients with stable angina, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), or STEMI.Methods: We used data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) on all patients in Sweden undergoing PCI (with or without FFR/iFR guidance) for stable angina, UA/NSTEMI, or STEMI between January 2005 and March 2018. The primary endpoint was all-cause mortality and the secondary endpoints were stent thrombosis or restenosis and periprocedural complications. The primary model was multilevel Cox proportional-hazards regression using an instrumental variable (IV) to adjust for known and unknown confounders with treating hospital as a treatment-preference instrument. The following variables were entered into Cox proportional-hazards regression in addition to the IV: age, sex, diabetes, indication for PCI, severity of coronary disease, smoking status, hypertension, hyperlipidemia, previous myocardial infarction, previous PCI, previous coronary artery bypass graft, type of stent.Results: In total, 151,001 patients underwent PCI: 31,514 (20.9%) for stable angina, 74,982 (49.6%) for UA/NSTEMI, and 44,505 (29.5%) for STEMI. Of these, FFR/iFR guidance was used in 11,433 patients (7.6%): 5029 (44.0%) with stable angina, 5989 (52.4%) with UA/NSTEMI, and 415 (3.6%) with STEMI; iFR was used in 1156 (10.1%) of these patients. After a median follow-up of 1784 (range 1–4824) days, the FFR/iFR group had lower adjusted risk estimates for all-cause mortality [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.69–0.91; P=0.001] and stent thrombosis and restenosis (HR 0.13; 95% CI 0.09–0.19; P<0.001). The number of periprocedural complications did not differ significantly between the groups (odds ratio 0.69; 95% CI 0.30–1.55; P=0.368). There was no interaction between FFR/iFR and indication for PCI. We found no difference between FFR and iFR (HR 1.12; 95% CI 0.90–1.59; P=0.216).Conclusions: In this observational study, the use of FFR/IFR was associated with a lower risk of long-term mortality in patients undergoing PCI for stable angina, UA/NSTEMI, or STEMI. Our study supports the current European and American guidelines for the use of FFR/iFR during PCI and shows that intracoronary pressure wire guidance has prognostic benefit in patients with stable angina as well as in patients with the acute coronary syndrome.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
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Volz, S.
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Redfors, B.
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Dworeck, C.
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Petursson, P.
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Gotberg, M.
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Jernberg, T.
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Linder, R.
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Ramunddal, T.
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Fröbert, Ole, 19 ...
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Witt, N.
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James, S.
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Erlinge, D.
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Omerovic, E.
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