RESUMEN
OBJECTIVES: We evaluated deferral of PCI of intermediate coronary lesions (IL) using fractional (FFR) and coronary flow reserve (CFR) hyperemic stenosis resistance index (HSR) in patients with a negative or nondiagnostic and noninvasive stress tests. BACKGROUND: Outcome after deferral of PCI of IL with discordant results between FFR and CFR is unknown. METHODS: PCI was deferred in 186 IL (mean diameter stenosis: 52%). Patients were divided according to the results of FFR and CFR in group A; FFR >or= 0.75 and CFR >or= 2.0 (n = 129), group B; FFR >or= 0.75 and CFR 2.0 (n = 28), group C; FFR 0.75 and CFR >or= 2.0 (n = 23) and group D; FFR 0.75 and CFR 2.0 (n = 6). Patients were followed for one year to document major adverse cardiac events (MACE). RESULTS: Nineteen MACEs (0 deaths, 4 myocardial infarctions, 1 CABG, and 14 PCIs) occurred during a follow up of 323 +/- 88 days. MACE rate was lowest (4.7%) when FFR, CFR, and HSR were normal. A higher MACE rate was observed when concordant abnormal (group D) or discordant results between FFR and CFR (group B and C) were compared to concordant normal values (group A, 33.3% vs. 19.7% vs. 5.4%, P = 0.008). Multivariate regression analysis showed a higher predictive power for HSR than for FFR and CFR. CONCLUSIONS: Abnormal FFR or abnormal CFR was documented in 31% of intermediate coronary lesions. Deferral of PCI in this group was associated with a high MACE rate, which underscores the rationale of combined pressure and flow measurements providing a stenosis resistance index that is better suited for clinical decision making in these lesions.
Asunto(s)
Estenosis Coronaria/diagnóstico , Estenosis Coronaria/terapia , Reserva del Flujo Fraccional Miocárdico/fisiología , Resistencia Vascular/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Angioplastia Coronaria con Balón , Velocidad del Flujo Sanguíneo , Cateterismo Cardíaco , Estudios de Cohortes , Angiografía Coronaria/métodos , Circulación Coronaria/fisiología , Estenosis Coronaria/mortalidad , Ecocardiografía Doppler , Femenino , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Probabilidad , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Presión Ventricular/fisiologíaRESUMEN
This study is the first that combines a serum marker of inflammation (C-reactive protein) and intracoronary-derived fractional flow reserve. A low C-reactive protein level was strongly associated with uncomplicated follow-up in patients with hemodynamic nonsignificant coronary lesions. These results show that C-reactive protein provides additional information relevant for clinical decision-making in patients with intermediate (30% to 70%) coronary lesions.