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Combined Assessment of FFR and CFR for Decision Making in Coronary Revascularization : From the Multicenter International ILIAS Registry. / van de Hoef, Tim P.; Lee, Joo Myung; Boerhout, Coen K. M. et al.

In: JACC. Cardiovascular interventions, Vol. 15, No. 10, 23.05.2022, p. 1047-1056.

Research output: Contribution to journalArticleAcademicpeer-review

Harvard

van de Hoef, TP, Lee, JM, Boerhout, CKM, de Waard, GA, Jung, J-H, Lee, SH, Mejía-Rentería, H, Hoshino, M, Echavarria-Pinto, M, Meuwissen, M, Matsuo, H, Madera-Cambero, M, Eftekhari, A, Effat, MA, Murai, T, Marques, K, Doh, J-H, Christiansen, EH, Banerjee, R, Nam, C-W, Niccoli, G, Nakayama, M, Tanaka, N, Shin, E-S, van Royen, N, Chamuleau, SAJ, Knaapen, P, Escaned, J, Kakuta, T, Koo, BK & Piek, JJ 2022, 'Combined Assessment of FFR and CFR for Decision Making in Coronary Revascularization: From the Multicenter International ILIAS Registry', JACC. Cardiovascular interventions, vol. 15, no. 10, pp. 1047-1056. https://doi.org/10.1016/j.jcin.2022.03.016

APA

van de Hoef, T. P., Lee, J. M., Boerhout, C. K. M., de Waard, G. A., Jung, J-H., Lee, S. H., Mejía-Rentería, H., Hoshino, M., Echavarria-Pinto, M., Meuwissen, M., Matsuo, H., Madera-Cambero, M., Eftekhari, A., Effat, M. A., Murai, T., Marques, K., Doh, J-H., Christiansen, E. H., Banerjee, R., ... Piek, J. J. (2022). Combined Assessment of FFR and CFR for Decision Making in Coronary Revascularization: From the Multicenter International ILIAS Registry. JACC. Cardiovascular interventions, 15(10), 1047-1056. https://doi.org/10.1016/j.jcin.2022.03.016

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BibTeX

@article{ba2062c3a08842b7ba49c4916293d220,
title = "Combined Assessment of FFR and CFR for Decision Making in Coronary Revascularization: From the Multicenter International ILIAS Registry",
abstract = "Objectives: The aim of this study was to demonstrate the clinical implications of combined assessment of fractional flow reserve (FFR) and coronary flow reserve (CFR). Background: Combined assessment of FFR and CFR allows detailed characterization of pathophysiology in chronic coronary syndromes. Data on the clinical implications of distinct FFR and CFR patterns are limited, leading to uncertainty regarding their relevance. Methods: Patients with chronic coronary syndromes and obstructive coronary artery disease were selected from the multicenter ILIAS (Inclusive Invasive Physiological Assessment in Angina Syndromes) registry. Patients were classified into 4 groups on the basis of FFR ≤0.80 and CFR <2.0. The endpoint was the 5-year target vessel failure (TVF) rate. Results: A total of 2,143 patients with 2,725 lesions were included. Compared with normal FFR/normal CFR, low FFR/low CFR carried the highest risk for TVF (HR: 5.4; 95% CI: 3.2-9.3; P < 0.001), significantly higher than in revascularized vessels (P = 0.007). Discordance, with either low FFR/normal CFR or normal FFR/low CFR, was associated with increased TVF rates compared with normal FFR/normal CFR (low FFR/normal CFR: HR: 3.5 [95% CI: 2.2-5.4; P < 0.001]; normal FFR/low CFR: HR: 3.0 [95% CI: 1.9-4.7; P < 0.001]). No difference in 5-year TVF was observed between the 2 discordant groups (P = 0.57) or between the discordant groups and the revascularized group (P = 0.26 vs low FFR/normal CFR; P = 0.60 vs normal FFR/low CFR). Conclusions: Impaired coronary hemodynamics are uniformly associated with increased 5-year TVF rates. Nonrevascularized vessels with discordant FFR and CFR are associated with 5-year event rates that are equivalent to those of vessels that undergo revascularization, whereas vessels with combined low FFR and CFR exhibit event rates that are significantly higher than after revascularization. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry]; NCT04485234)",
keywords = "coronary flow reserve, fractional flow reserve, percutaneous coronary intervention",
author = "{van de Hoef}, {Tim P.} and Lee, {Joo Myung} and Boerhout, {Coen K. M.} and {de Waard}, {Guus A.} and Ji-Hyun Jung and Lee, {Seung Hun} and Hern{\'a}n Mej{\'i}a-Renter{\'i}a and Masahiro Hoshino and Mauro Echavarria-Pinto and Martijn Meuwissen and Hitoshi Matsuo and Maribel Madera-Cambero and Ashkan Eftekhari and Effat, {Mohamed A.} and Tadashi Murai and Koen Marques and Joon-Hyung Doh and Christiansen, {Evald H.} and Rupak Banerjee and Chang-Wook Nam and Giampaolo Niccoli and Masafumi Nakayama and Nobuhiro Tanaka and Eun-Seok Shin and {van Royen}, Niels and Chamuleau, {Steven A. J.} and Paul Knaapen and Javier Escaned and Tsunekazu Kakuta and Koo, {Bon Kwon} and Piek, {Jan J.}",
note = "Funding Information: Dr van de Hoef has received speaker fees and institutional research grants from Abbott and Philips. Dr J.M. Lee has received research grants from Abbott and Philips. Dr Echavarria-Pinto has received speaker fees from Abbott and Philips. Dr van Royen has received speaker fees and institutional research grants from Abbott and Philips. Dr Escaned is a speaker and consultant for Abbott, Boston Scientific, and Philips; and has received personal fees from Philips, Boston Scientific, and Abbott/St. Jude Medical outside the submitted work. Dr Koo has received institutional research grants from Abbott Vascular and Philips Volcano. Dr Piek has received support as a consultant for Philips/Volcano; and has received institutional research grants from Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: In vessels in which both FFR and CFR were low but revascularization was deferred, 5-year TVF rates were significantly higher than in revascularized vessels, supporting a clinical relevance of revascularization in vessels with such severely disrupted coronary hemodynamics. These data are important in light of the results of the ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) and ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trials.17,18 The data from ORBITA, ISCHEMIA, and FAME II document that a restrictive approach to coronary revascularization is safe and does not lead to impaired clinical outcomes and that an FFR-guided strategy improves but does not optimize patient selection for revascularization. With the use of CFR as a complementary diagnostic technique, the data from the ILIAS registry suggest that lesions with low FFR and low CFR benefit most from revascularization, as their deferral is associated with events rates that are significantly higher than those observed after coronary revascularization. As such, our findings support the hypothesis that combined FFR and CFR assessment allows to enhance the identification of patients in whom the risk/benefit ratio favors revascularization over medical therapy for the prevention of future adverse events. These data further support the development of a randomized trial evaluating the safety and cost efficacy of a combined FFR- and CFR-guided intervention strategy in comparison with an FFR-guided strategy to further inform clinical practice regarding optimizing lesion selection for revascularization. Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",
year = "2022",
month = may,
day = "23",
doi = "10.1016/j.jcin.2022.03.016",
language = "English",
volume = "15",
pages = "1047--1056",
journal = "JACC. Cardiovascular interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "10",

}

RIS

TY - JOUR

T1 - Combined Assessment of FFR and CFR for Decision Making in Coronary Revascularization

T2 - From the Multicenter International ILIAS Registry

AU - van de Hoef, Tim P.

AU - Lee, Joo Myung

AU - Boerhout, Coen K. M.

AU - de Waard, Guus A.

AU - Jung, Ji-Hyun

AU - Lee, Seung Hun

AU - Mejía-Rentería, Hernán

AU - Hoshino, Masahiro

AU - Echavarria-Pinto, Mauro

AU - Meuwissen, Martijn

AU - Matsuo, Hitoshi

AU - Madera-Cambero, Maribel

AU - Eftekhari, Ashkan

AU - Effat, Mohamed A.

AU - Murai, Tadashi

AU - Marques, Koen

AU - Doh, Joon-Hyung

AU - Christiansen, Evald H.

AU - Banerjee, Rupak

AU - Nam, Chang-Wook

AU - Niccoli, Giampaolo

AU - Nakayama, Masafumi

AU - Tanaka, Nobuhiro

AU - Shin, Eun-Seok

AU - van Royen, Niels

AU - Chamuleau, Steven A. J.

AU - Knaapen, Paul

AU - Escaned, Javier

AU - Kakuta, Tsunekazu

AU - Koo, Bon Kwon

AU - Piek, Jan J.

N1 - Funding Information: Dr van de Hoef has received speaker fees and institutional research grants from Abbott and Philips. Dr J.M. Lee has received research grants from Abbott and Philips. Dr Echavarria-Pinto has received speaker fees from Abbott and Philips. Dr van Royen has received speaker fees and institutional research grants from Abbott and Philips. Dr Escaned is a speaker and consultant for Abbott, Boston Scientific, and Philips; and has received personal fees from Philips, Boston Scientific, and Abbott/St. Jude Medical outside the submitted work. Dr Koo has received institutional research grants from Abbott Vascular and Philips Volcano. Dr Piek has received support as a consultant for Philips/Volcano; and has received institutional research grants from Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: In vessels in which both FFR and CFR were low but revascularization was deferred, 5-year TVF rates were significantly higher than in revascularized vessels, supporting a clinical relevance of revascularization in vessels with such severely disrupted coronary hemodynamics. These data are important in light of the results of the ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) and ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trials.17,18 The data from ORBITA, ISCHEMIA, and FAME II document that a restrictive approach to coronary revascularization is safe and does not lead to impaired clinical outcomes and that an FFR-guided strategy improves but does not optimize patient selection for revascularization. With the use of CFR as a complementary diagnostic technique, the data from the ILIAS registry suggest that lesions with low FFR and low CFR benefit most from revascularization, as their deferral is associated with events rates that are significantly higher than those observed after coronary revascularization. As such, our findings support the hypothesis that combined FFR and CFR assessment allows to enhance the identification of patients in whom the risk/benefit ratio favors revascularization over medical therapy for the prevention of future adverse events. These data further support the development of a randomized trial evaluating the safety and cost efficacy of a combined FFR- and CFR-guided intervention strategy in comparison with an FFR-guided strategy to further inform clinical practice regarding optimizing lesion selection for revascularization. Publisher Copyright: © 2022 American College of Cardiology Foundation

PY - 2022/5/23

Y1 - 2022/5/23

N2 - Objectives: The aim of this study was to demonstrate the clinical implications of combined assessment of fractional flow reserve (FFR) and coronary flow reserve (CFR). Background: Combined assessment of FFR and CFR allows detailed characterization of pathophysiology in chronic coronary syndromes. Data on the clinical implications of distinct FFR and CFR patterns are limited, leading to uncertainty regarding their relevance. Methods: Patients with chronic coronary syndromes and obstructive coronary artery disease were selected from the multicenter ILIAS (Inclusive Invasive Physiological Assessment in Angina Syndromes) registry. Patients were classified into 4 groups on the basis of FFR ≤0.80 and CFR <2.0. The endpoint was the 5-year target vessel failure (TVF) rate. Results: A total of 2,143 patients with 2,725 lesions were included. Compared with normal FFR/normal CFR, low FFR/low CFR carried the highest risk for TVF (HR: 5.4; 95% CI: 3.2-9.3; P < 0.001), significantly higher than in revascularized vessels (P = 0.007). Discordance, with either low FFR/normal CFR or normal FFR/low CFR, was associated with increased TVF rates compared with normal FFR/normal CFR (low FFR/normal CFR: HR: 3.5 [95% CI: 2.2-5.4; P < 0.001]; normal FFR/low CFR: HR: 3.0 [95% CI: 1.9-4.7; P < 0.001]). No difference in 5-year TVF was observed between the 2 discordant groups (P = 0.57) or between the discordant groups and the revascularized group (P = 0.26 vs low FFR/normal CFR; P = 0.60 vs normal FFR/low CFR). Conclusions: Impaired coronary hemodynamics are uniformly associated with increased 5-year TVF rates. Nonrevascularized vessels with discordant FFR and CFR are associated with 5-year event rates that are equivalent to those of vessels that undergo revascularization, whereas vessels with combined low FFR and CFR exhibit event rates that are significantly higher than after revascularization. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry]; NCT04485234)

AB - Objectives: The aim of this study was to demonstrate the clinical implications of combined assessment of fractional flow reserve (FFR) and coronary flow reserve (CFR). Background: Combined assessment of FFR and CFR allows detailed characterization of pathophysiology in chronic coronary syndromes. Data on the clinical implications of distinct FFR and CFR patterns are limited, leading to uncertainty regarding their relevance. Methods: Patients with chronic coronary syndromes and obstructive coronary artery disease were selected from the multicenter ILIAS (Inclusive Invasive Physiological Assessment in Angina Syndromes) registry. Patients were classified into 4 groups on the basis of FFR ≤0.80 and CFR <2.0. The endpoint was the 5-year target vessel failure (TVF) rate. Results: A total of 2,143 patients with 2,725 lesions were included. Compared with normal FFR/normal CFR, low FFR/low CFR carried the highest risk for TVF (HR: 5.4; 95% CI: 3.2-9.3; P < 0.001), significantly higher than in revascularized vessels (P = 0.007). Discordance, with either low FFR/normal CFR or normal FFR/low CFR, was associated with increased TVF rates compared with normal FFR/normal CFR (low FFR/normal CFR: HR: 3.5 [95% CI: 2.2-5.4; P < 0.001]; normal FFR/low CFR: HR: 3.0 [95% CI: 1.9-4.7; P < 0.001]). No difference in 5-year TVF was observed between the 2 discordant groups (P = 0.57) or between the discordant groups and the revascularized group (P = 0.26 vs low FFR/normal CFR; P = 0.60 vs normal FFR/low CFR). Conclusions: Impaired coronary hemodynamics are uniformly associated with increased 5-year TVF rates. Nonrevascularized vessels with discordant FFR and CFR are associated with 5-year event rates that are equivalent to those of vessels that undergo revascularization, whereas vessels with combined low FFR and CFR exhibit event rates that are significantly higher than after revascularization. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry]; NCT04485234)

KW - coronary flow reserve

KW - fractional flow reserve

KW - percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85129751625&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2022.03.016

DO - 10.1016/j.jcin.2022.03.016

M3 - Article

C2 - 35589234

VL - 15

SP - 1047

EP - 1056

JO - JACC. Cardiovascular interventions

JF - JACC. Cardiovascular interventions

SN - 1936-8798

IS - 10

ER -

ID: 23554224