title: Factors associated with deferred lesion failure following fractional flow reserve assessment in patients with diabetes mellitus.
abstract: OBJECTIVE
  To explore the predictors of deferred lesion failure (DLF) in patients with diabetes mellitus (DM) and lesions with a fractional flow reserve (FFR) >0.80 and to examine whether a predictive relationship between negative FFR values (>0.80-1.00) and DLF exists.
  
  
  BACKGROUND
  DM is associated with rapidly progressive atherosclerosis and predictors of DLF in FFR negative lesions in this high-risk group are unknown.
  
  
  METHODS
  All DM patients who underwent FFR-assessment between 1/01/2010 and 31/12/2013 were included, and followed until 1/7/2015. Patients carrying ≥1 FFR negative lesion(s) were assessed for DLF, and multivariate models used to identify independent factors associated with DLF.
  
  
  RESULTS
  A total of 205 patients with 252 FFR >0.80 lesions were identified. At a mean follow-up of 3.1 ± 1.4 years, DLF occurred in 29/205 (14.1%) patients, 31/252 (12.3%) lesions. Using marginal Cox regression multivariate analysis, insulin requiring DM [HR 2.24 (95%CI; 1.01-4.95), P = 0.046] and prior revascularization [HR 2.70 (95%CI 1.21-6.01), P = 0.015] were identified as being associated with a higher incidence of DLF. Absolute FFR values in FFR negative lesions in DM patients are not predictive of DLF (receiver operating characteristics curve analysis: area under the curve: 0.57 ± 0.06, 95%CI 0.46-0.69).
  
  
  CONCLUSIONS
  In DM patients with FFR negative lesions, insulin requiring DM and prior revascularization are predictors for DLF. In contrast to non-DM patients, no predictive relationship between absolute negative FFR values (ranging >0.80-1.00) and the risk of DLF exists in DM patients. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Isala Hartcentrum, Zwolle, The Netherlands.|Diagram CRO, Zwolle, The Netherlands.
authors.forename: Mark W
authors.identifier: http://orcid.org/0000-0002-5071-6221
authors.initials: MW
authors.lastname: Kennedy
authors.affiliation: Isala Hartcentrum, Zwolle, The Netherlands.|Diagram CRO, Zwolle, The Netherlands.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fabris
authors.affiliation: Isala Hartcentrum, Zwolle, The Netherlands.
authors.forename: Renicus S
authors.initials: RS
authors.lastname: Hermanides
authors.affiliation: Isala Hartcentrum, Zwolle, The Netherlands.
authors.forename: Emel
authors.initials: E
authors.lastname: Kaplan
authors.affiliation: Isala Hartcentrum, Zwolle, The Netherlands.
authors.forename: Nanette
authors.initials: N
authors.lastname: Borren
authors.affiliation: Isala Hartcentrum, Zwolle, The Netherlands.|Diagram CRO, Zwolle, The Netherlands.
authors.forename: Balazs
authors.initials: B
authors.lastname: Berta
authors.affiliation: Diagram CRO, Zwolle, The Netherlands.
authors.forename: Petra C
authors.initials: PC
authors.lastname: Koopmans
authors.affiliation: Isala Hartcentrum, Zwolle, The Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Isala Hartcentrum, Zwolle, The Netherlands.|Diagram CRO, Zwolle, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.affiliation: Isala Hartcentrum, Zwolle, The Netherlands.
authors.forename: Elvin
authors.initials: E
authors.lastname: Kedhi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000009:adverse effects*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: deferred lesion failure; diabetes mellitus; fractional flow reserve