Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation

Seokhun Yang; Jinlong Zhang; Doyeon Hwang; Joo Myung Lee; Chang Wook Nam; Eun Seok Shin; Joon Hyung Doh; Masahiro Hoshino; Rikuta Hamaya; Yoshihisa Kanaji; Tadashi Murai; Jun Jie Zhang; Fei Ye; Xiaobo Li; Zhen Ge; Shao Liang Chen; Tsunekazu Kakuta; Bon Kwon Koo

doi:10.3389/fcvm.2021.696756

Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation

Seokhun Yang
, Jinlong Zhang
, Doyeon Hwang
, Joo Myung Lee
, Chang Wook Nam
, Eun Seok Shin
, Joon Hyung Doh
, Masahiro Hoshino
, Rikuta Hamaya
, Yoshihisa Kanaji
, Tadashi Murai
, Jun Jie Zhang
, Fei Ye
, Xiaobo Li
, Zhen Ge
, Shao Liang Chen
, Tsunekazu Kakuta
, Bon Kwon Koo

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Objectives: We investigated the influence of coronary disease characteristics on prognostic implications of residual ischemia after coronary stent implantation. Methods: This study included 1,476 patients with drug-eluting stent implantation and available pre- and post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) measurements. Residual ischemia was defined as post-PCI FFR ≤ 0.80. Coronary disease characteristics with significant interaction hazard ratios (HRs) for clinical outcomes with residual ischemia were defined as interaction characteristics with residual ischemia (ICwRI). The primary outcome was target vessel failure (TVF)—a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization—at 2 years. Results: The mean pre- and post-PCI FFR were 0.68 ± 0.11 and 0.87 ± 0.07, respectively. During the median follow-up duration of 2.0 years, the cumulative incidence of TVF was 6.1%. The 203 vessels (13.8%) with residual ischemia had higher risks of TVF compared to that for post-PCI FFR >0.80 (P < 0.001). ICwRI with a significant interaction HR with residual ischemia included pre-PCI SYNTAX score >17 and pre-PCI FFR ≤ 0.62. Each ICwRI had a direct prognostic effect not mediated by residual ischemia. The association between an increased TVF risk and residual ischemia was significant in patients with 0 or 1 ICwRI [hazard ratio (HR) 3.25, 95% confidence interval (CI) 1.90–5.57, P < 0.001] but not in those with 2 ICwRI (HR 0.47, 95% CI 0.14–1.64, P = 0.24). Among patients with post-PCI FFR >0.80, those with 2 ICwRI showed similar TVF risks to those with residual ischemia (HR 1.55, 95% CI 0.79–3.02, P = 0.20). Conclusions: Coronary disease characteristics including pre-PCI SYNTAX score and pre-PCI FFR affected the prognostic implications of residual ischemia. The prognostic relevance of residual ischemia was attenuated in patients with multiple interacting characteristics.

Original language	English
Article number	696756
Journal	Frontiers in Cardiovascular Medicine
Volume	8
DOIs	https://doi.org/10.3389/fcvm.2021.696756
State	Published - 2021

Keywords

atherosclerosis
coronary artery disease
fractional flow reserve
percutaneous coronary intervention
residual ischemia

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3389/fcvm.2021.696756

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Yang, S., Zhang, J., Hwang, D., Lee, J. M., Nam, C. W., Shin, E. S., Doh, J. H., Hoshino, M., Hamaya, R., Kanaji, Y., Murai, T., Zhang, J. J., Ye, F., Li, X., Ge, Z., Chen, S. L., Kakuta, T., & Koo, B. K. (2021). Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation. Frontiers in Cardiovascular Medicine, 8, Article 696756. https://doi.org/10.3389/fcvm.2021.696756

@article{bb1461e6cd82402399df970bd8ccb148,

title = "Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation",

abstract = "Objectives: We investigated the influence of coronary disease characteristics on prognostic implications of residual ischemia after coronary stent implantation. Methods: This study included 1,476 patients with drug-eluting stent implantation and available pre- and post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) measurements. Residual ischemia was defined as post-PCI FFR ≤ 0.80. Coronary disease characteristics with significant interaction hazard ratios (HRs) for clinical outcomes with residual ischemia were defined as interaction characteristics with residual ischemia (ICwRI). The primary outcome was target vessel failure (TVF)—a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization—at 2 years. Results: The mean pre- and post-PCI FFR were 0.68 ± 0.11 and 0.87 ± 0.07, respectively. During the median follow-up duration of 2.0 years, the cumulative incidence of TVF was 6.1\%. The 203 vessels (13.8\%) with residual ischemia had higher risks of TVF compared to that for post-PCI FFR >0.80 (P < 0.001). ICwRI with a significant interaction HR with residual ischemia included pre-PCI SYNTAX score >17 and pre-PCI FFR ≤ 0.62. Each ICwRI had a direct prognostic effect not mediated by residual ischemia. The association between an increased TVF risk and residual ischemia was significant in patients with 0 or 1 ICwRI [hazard ratio (HR) 3.25, 95\% confidence interval (CI) 1.90–5.57, P < 0.001] but not in those with 2 ICwRI (HR 0.47, 95\% CI 0.14–1.64, P = 0.24). Among patients with post-PCI FFR >0.80, those with 2 ICwRI showed similar TVF risks to those with residual ischemia (HR 1.55, 95\% CI 0.79–3.02, P = 0.20). Conclusions: Coronary disease characteristics including pre-PCI SYNTAX score and pre-PCI FFR affected the prognostic implications of residual ischemia. The prognostic relevance of residual ischemia was attenuated in patients with multiple interacting characteristics.",

keywords = "atherosclerosis, coronary artery disease, fractional flow reserve, percutaneous coronary intervention, residual ischemia",

author = "Seokhun Yang and Jinlong Zhang and Doyeon Hwang and Lee, \{Joo Myung\} and Nam, \{Chang Wook\} and Shin, \{Eun Seok\} and Doh, \{Joon Hyung\} and Masahiro Hoshino and Rikuta Hamaya and Yoshihisa Kanaji and Tadashi Murai and Zhang, \{Jun Jie\} and Fei Ye and Xiaobo Li and Zhen Ge and Chen, \{Shao Liang\} and Tsunekazu Kakuta and Koo, \{Bon Kwon\}",

note = "Publisher Copyright: Copyright {\textcopyright} 2021 Yang, Zhang, Hwang, Lee, Nam, Shin, Doh, Hoshino, Hamaya, Kanaji, Murai, Zhang, Ye, Li, Ge, Chen, Kakuta and Koo.",

year = "2021",

doi = "10.3389/fcvm.2021.696756",

language = "English",

volume = "8",

journal = "Frontiers in Cardiovascular Medicine",

issn = "2297-055X",

publisher = "Frontiers Media SA",

}

Yang, S, Zhang, J, Hwang, D, Lee, JM, Nam, CW, Shin, ES, Doh, JH, Hoshino, M, Hamaya, R, Kanaji, Y, Murai, T, Zhang, JJ, Ye, F, Li, X, Ge, Z, Chen, SL, Kakuta, T & Koo, BK 2021, 'Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation', Frontiers in Cardiovascular Medicine, vol. 8, 696756. https://doi.org/10.3389/fcvm.2021.696756

TY - JOUR

T1 - Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation

AU - Yang, Seokhun

AU - Zhang, Jinlong

AU - Hwang, Doyeon

AU - Lee, Joo Myung

AU - Nam, Chang Wook

AU - Shin, Eun Seok

AU - Doh, Joon Hyung

AU - Hoshino, Masahiro

AU - Hamaya, Rikuta

AU - Kanaji, Yoshihisa

AU - Murai, Tadashi

AU - Zhang, Jun Jie

AU - Ye, Fei

AU - Li, Xiaobo

AU - Ge, Zhen

AU - Chen, Shao Liang

AU - Kakuta, Tsunekazu

AU - Koo, Bon Kwon

PY - 2021

Y1 - 2021

N2 - Objectives: We investigated the influence of coronary disease characteristics on prognostic implications of residual ischemia after coronary stent implantation. Methods: This study included 1,476 patients with drug-eluting stent implantation and available pre- and post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) measurements. Residual ischemia was defined as post-PCI FFR ≤ 0.80. Coronary disease characteristics with significant interaction hazard ratios (HRs) for clinical outcomes with residual ischemia were defined as interaction characteristics with residual ischemia (ICwRI). The primary outcome was target vessel failure (TVF)—a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization—at 2 years. Results: The mean pre- and post-PCI FFR were 0.68 ± 0.11 and 0.87 ± 0.07, respectively. During the median follow-up duration of 2.0 years, the cumulative incidence of TVF was 6.1%. The 203 vessels (13.8%) with residual ischemia had higher risks of TVF compared to that for post-PCI FFR >0.80 (P < 0.001). ICwRI with a significant interaction HR with residual ischemia included pre-PCI SYNTAX score >17 and pre-PCI FFR ≤ 0.62. Each ICwRI had a direct prognostic effect not mediated by residual ischemia. The association between an increased TVF risk and residual ischemia was significant in patients with 0 or 1 ICwRI [hazard ratio (HR) 3.25, 95% confidence interval (CI) 1.90–5.57, P < 0.001] but not in those with 2 ICwRI (HR 0.47, 95% CI 0.14–1.64, P = 0.24). Among patients with post-PCI FFR >0.80, those with 2 ICwRI showed similar TVF risks to those with residual ischemia (HR 1.55, 95% CI 0.79–3.02, P = 0.20). Conclusions: Coronary disease characteristics including pre-PCI SYNTAX score and pre-PCI FFR affected the prognostic implications of residual ischemia. The prognostic relevance of residual ischemia was attenuated in patients with multiple interacting characteristics.

AB - Objectives: We investigated the influence of coronary disease characteristics on prognostic implications of residual ischemia after coronary stent implantation. Methods: This study included 1,476 patients with drug-eluting stent implantation and available pre- and post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) measurements. Residual ischemia was defined as post-PCI FFR ≤ 0.80. Coronary disease characteristics with significant interaction hazard ratios (HRs) for clinical outcomes with residual ischemia were defined as interaction characteristics with residual ischemia (ICwRI). The primary outcome was target vessel failure (TVF)—a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization—at 2 years. Results: The mean pre- and post-PCI FFR were 0.68 ± 0.11 and 0.87 ± 0.07, respectively. During the median follow-up duration of 2.0 years, the cumulative incidence of TVF was 6.1%. The 203 vessels (13.8%) with residual ischemia had higher risks of TVF compared to that for post-PCI FFR >0.80 (P < 0.001). ICwRI with a significant interaction HR with residual ischemia included pre-PCI SYNTAX score >17 and pre-PCI FFR ≤ 0.62. Each ICwRI had a direct prognostic effect not mediated by residual ischemia. The association between an increased TVF risk and residual ischemia was significant in patients with 0 or 1 ICwRI [hazard ratio (HR) 3.25, 95% confidence interval (CI) 1.90–5.57, P < 0.001] but not in those with 2 ICwRI (HR 0.47, 95% CI 0.14–1.64, P = 0.24). Among patients with post-PCI FFR >0.80, those with 2 ICwRI showed similar TVF risks to those with residual ischemia (HR 1.55, 95% CI 0.79–3.02, P = 0.20). Conclusions: Coronary disease characteristics including pre-PCI SYNTAX score and pre-PCI FFR affected the prognostic implications of residual ischemia. The prognostic relevance of residual ischemia was attenuated in patients with multiple interacting characteristics.

KW - atherosclerosis

KW - coronary artery disease

KW - fractional flow reserve

KW - percutaneous coronary intervention

KW - residual ischemia

UR - https://www.scopus.com/pages/publications/85139022484

U2 - 10.3389/fcvm.2021.696756

DO - 10.3389/fcvm.2021.696756

M3 - Article

AN - SCOPUS:85139022484

SN - 2297-055X

VL - 8

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

M1 - 696756

ER -

Effect of Coronary Disease Characteristics on Prognostic Relevance of Residual Ischemia After Stent Implantation

Abstract

Keywords

UN SDGs

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