title: Risk model for estimating the 1-year risk of deferred lesion intervention following deferred revascularization after fractional flow reserve assessment.
abstract: OBJECTIVE
  Although lesions deferred revascularization following fractional flow reserve (FFR) assessment have a low risk of adverse cardiac events, variability in risk for deferred lesion intervention (DLI) has not been previously evaluated. The aim of this study was to develop a prediction model to estimate 1-year risk of DLI for coronary lesions where revascularization was not performed following FFR assessment.
  
  
  RESULTS
  A prediction model for DLI was developed from a cohort of 721 patients with 882 coronary lesions where revascularization was deferred based on FFR between 10/2002 and 7/2010. Deferred lesion intervention was defined as any revascularization of a lesion previously deferred following FFR. The final DLI model was developed using stepwise Cox regression and validated using bootstrapping techniques. An algorithm was constructed to predict the 1-year risk of DLI. During a mean (±SD) follow-up period of 4.0 ± 2.3 years, 18% of lesions deferred after FFR underwent DLI; the 1-year incidence of DLI was 5.3%, while the predicted risk of DLI varied from 1 to 40%. The final Cox model included the FFR value, age, current or former smoking, history of coronary artery disease (CAD) or prior percutaneous coronary intervention, multi-vessel CAD, and serum creatinine. The c statistic for the DLI prediction model was 0.66 (95% confidence interval, CI: 0.61-0.70).
  
  
  CONCLUSIONS
  Patients deferred revascularization based on FFR have variation in their risk for DLI. A clinical prediction model consisting of five clinical variables and the FFR value can help predict the risk of DLI in the first year following FFR assessment.
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Jeremiah P
authors.initials: JP
authors.lastname: Depta
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Jayendrakumar S
authors.initials: JS
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Gage
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Shriti K
authors.initials: SK
authors.lastname: Masrani
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: David
authors.initials: D
authors.lastname: Raymer
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Facey
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Zajarias
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Lasala
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Amin
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Howard I
authors.initials: HI
authors.lastname: Kurz
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA jzsingh@dom.wustl.edu.
authors.forename: Jasvindar
authors.initials: J
authors.lastname: Singh
authors.affiliation: Division of Cardiology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, PO Box 8086, St. Louis, MO 63110, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
mesh_terms: D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000628:therapy*; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D062645:Percutaneous Coronary Intervention; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: Deferred lesion intervention; Fractional flow reserve