Relation between fractional flow reserve value of coronary lesions with deferred revascularization and cardiovascular outcomes in non-diabetic and diabetic patients.
BACKGROUND
FFR of deferred PCI lesions can predict future cardiovascular events. However, the prognostic utility of FFR remains unclear in diabetic patients in view of the potential impact of the diffuse nature of vascular disease process. We aimed to study the relation between fractional flow reserve (FFR) values and long-term outcomes of diabetic and non-diabetic patients with deferred percutaneous coronary intervention (PCI).


METHODS
Patients with FFR assessment and deferred PCI (n=630) were enrolled and stratified according to diabetes mellitus (DM) status and FFR values. Patients were followed over a median of 39months. Cox proportional hazard regression models were used to analyze the association between clinical endpoints and clinical factors such as DM and FFR.


RESULTS
In non-diabetics (n=450), higher FFR values were associated with less cardiovascular events (hazard ratio (HR) for death and myocardial infarction (MI) [95% confidence interval (CI)], 0.61[0.44 to 0.86] per 0.1 increase in FFR, p=0.007; HR for revascularization [95%CI], 0.66[0.49 to 0.9] per 0.1 increase in FFR, p=0.006). In diabetics (n=180), there was no difference in death and MI across the range of FFR values. Among those patients with an FFR >0.85, diabetics had a more than two-fold higher risk of death and MI than non-diabetics (HR [95% CI], 2.20 [1.19 to 4.01], p=0.015).


CONCLUSIONS
Among non-diabetic patients with deferred PCI, a higher FFR was associated with lower rates of death, MI and revascularization. On the contrary in diabetic patients with deferred revascularization, FFR was not able to differentiate the risk of cardiovascular events.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, Xuanwu Hospital Capital Medical University, Beijing 100053, China.
Zhi
Z
Liu
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Yasushi
Y
Matsuzawa
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Joerg
J
Herrmann
Division of Cardiology, Xuanwu Hospital Capital Medical University, Beijing 100053, China.
Jing
J
Li
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Ryan J
RJ
Lennon
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Daniel J
DJ
Crusan
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Taek-Geun
TG
Kwon
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Ming
M
Zhang
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Tao
T
Sun
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Shiwei
S
Yang
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Rajiv
R
Gulati
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Malcolm R
MR
Bell
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
Lilach O
LO
Lerman
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address: lerman.amir@mayo.edu.
Amir
A
Lerman
D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D012042:Registries; D016896:Treatment Outcome
Deferred revascularization; Diabetes mellitus; Fractional flow reserve; Prognosis