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28 results on '"Doh, Joon-Hyung"'

1. Impact of sex on the assessment of the microvascular resistance reserve

Author: Cardiologie, Team Medisch, Circulatory Health, Boerhout, Coen K.M., Vink, C. E.M., Lee, Joo Myung, de Waard, Guus A., Mejia-Renteria, Hernan, Lee, Seung Hun, Jung, Ji Hyun, Hoshino, Masahiro, Echavarria-Pinto, Mauro, Meuwissen, Martijn, Matsuo, Hitoshi, Madera-Cambero, Maribel, Eftekhari, Ashkan, Effat, Mohamed A., Murai, Tadashi, Marques, Koen, Doh, Joon Hyung, Christiansen, Evald H., Banerjee, Rupak, Nam, Chang Wook, Niccoli, Giampaolo, Nakayama, Masafumi, Tanaka, Nobuhiro, Shin, Eun Seok, Appelman, Yolande, Beijk, Marcel A.M., van Royen, Niels, Chamuleau, Steven A.J., Knaapen, Paul, Escaned, Javier, Kakuta, Tsunekazu, Koo, Bon Kwon, Piek, Jan J., van de Hoef, Tim P., Cardiologie, Team Medisch, Circulatory Health, Boerhout, Coen K.M., Vink, C. E.M., Lee, Joo Myung, de Waard, Guus A., Mejia-Renteria, Hernan, Lee, Seung Hun, Jung, Ji Hyun, Hoshino, Masahiro, Echavarria-Pinto, Mauro, Meuwissen, Martijn, Matsuo, Hitoshi, Madera-Cambero, Maribel, Eftekhari, Ashkan, Effat, Mohamed A., Murai, Tadashi, Marques, Koen, Doh, Joon Hyung, Christiansen, Evald H., Banerjee, Rupak, Nam, Chang Wook, Niccoli, Giampaolo, Nakayama, Masafumi, Tanaka, Nobuhiro, Shin, Eun Seok, Appelman, Yolande, Beijk, Marcel A.M., van Royen, Niels, Chamuleau, Steven A.J., Knaapen, Paul, Escaned, Javier, Kakuta, Tsunekazu, Koo, Bon Kwon, Piek, Jan J., and van de Hoef, Tim P.
Published: 2024

2. Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications

Author: Yang, Seokhun, Hwang, Doyeon, Zhang, Jinlong, Park, Jiesuck, Yun, Jun Pil, Lee, Joo Myung, Nam, Chang Wook, Shin, Eun Seok, Doh, Joon Hyung, Chen, Shao Liang, Kakuta, Tsunekazu, Toth, Gabor G., Piroth, Zsolt, Johnson, Nils P., Hakeem, Abdul, Uretsky, Barry F., Hokama, Yohei, Tanaka, Nobuhiro, Lim, Hong Seok, Ito, Tsuyoshi, Matsuo, Akiko, Azzalini, Lorenzo, Leesar, Massoud A., Neleman, Tara, van Mieghem, Nicolas M., Diletti, Roberto, Daemen, Joost, Collison, Damien, Collet, Carlos, De Bruyne, Bernard, Koo, Bon Kwon, Yang, Seokhun, Hwang, Doyeon, Zhang, Jinlong, Park, Jiesuck, Yun, Jun Pil, Lee, Joo Myung, Nam, Chang Wook, Shin, Eun Seok, Doh, Joon Hyung, Chen, Shao Liang, Kakuta, Tsunekazu, Toth, Gabor G., Piroth, Zsolt, Johnson, Nils P., Hakeem, Abdul, Uretsky, Barry F., Hokama, Yohei, Tanaka, Nobuhiro, Lim, Hong Seok, Ito, Tsuyoshi, Matsuo, Akiko, Azzalini, Lorenzo, Leesar, Massoud A., Neleman, Tara, van Mieghem, Nicolas M., Diletti, Roberto, Daemen, Joost, Collison, Damien, Collet, Carlos, De Bruyne, Bernard, and Koo, Bon Kwon
Abstract: Background:Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods and Results:From an individual patient data meta-analysis of 17 cohorts of patients who underwent post-PCI fractional flow reserve measurement after drug-eluting stent implantation, 2081 patients with available clinical and vessel characteristics were analyzed. The primary outcome was cardiac death or target-vessel myocardial infarction at 2 years. The mean age of patients was 64.2±10.2 years, and the mean angiographic percent diameter stenosis was 63.9%±14.3%. Among 11 clinical and 8 vessel features, 4 adverse clinical characteristics (age ≥65 years, diabetes, chronic kidney disease, and left ventricular ejection fraction <50%) and 2 adverse vessel characteristics (post-PCI fractional flow reserve ≤0.80 and total stent length ≥54 mm) were identified to independently predict the primary outcome (all P<0.05). The number of adverse vessel characteristics had additive predictability for the primary end point to that of adverse clinical characteristics (area under the curve 0.72 versus 0.78; P=0.03) and vice versa (area under the curve 0.68 versus 0.78; P=0.03). The cumulative event rate increased in the order of none, either, and both of adverse clinical characteristics ≥2 and adverse vessel characteristics ≥1 (0.3%, 2.4%, and 5.3%; P for trend <0.01). Conclusions:In patients undergoing drug-eluting stent implantation, adverse clinical and vessel characteristics were associated with the risk of cardiac death or target-vessel myocardial infarction. Because these characteristics showed independent and additive prognostic value, their integrative assessment can optimize post-PCI risk stra
Published: 2023

3. Changes in microvascular resistance following percutaneous coronary intervention - From the ILIAS global registry

Author: Team Medisch, Eftekhari, Ashkan, van de Hoef, Tim P, Hoshino, Masahiro, Lee, Joo Myung, Boerhout, Coen K M, de Waard, Guus A, Jung, Ji-Hyun, Lee, Seung Hun, Mejia-Renteria, Hernan, Echavarria-Pinto, Mauro, Meuwissen, Martijn, Matsuo, Hitoshi, Madera-Cambero, Maribel, Effat, Mohamed A, Marques, Koen, Doh, Joon-Hyung, Banerjee, Rupak, Nam, Chang-Wook, Niccoli, Giampaolo, Murai, Tadashi, Nakayama, Masafumi, Tanaka, Nobuhiro, Shin, Eun-Seok, Knaapen, Paul, van Royen, Niels, Escaned, Javier, Koo, Bon Kwon, Chamuleau, Steven A J, Kakuta, Tsunekazu, Piek, Jan J, Christiansen, Evald Høj, Team Medisch, Eftekhari, Ashkan, van de Hoef, Tim P, Hoshino, Masahiro, Lee, Joo Myung, Boerhout, Coen K M, de Waard, Guus A, Jung, Ji-Hyun, Lee, Seung Hun, Mejia-Renteria, Hernan, Echavarria-Pinto, Mauro, Meuwissen, Martijn, Matsuo, Hitoshi, Madera-Cambero, Maribel, Effat, Mohamed A, Marques, Koen, Doh, Joon-Hyung, Banerjee, Rupak, Nam, Chang-Wook, Niccoli, Giampaolo, Murai, Tadashi, Nakayama, Masafumi, Tanaka, Nobuhiro, Shin, Eun-Seok, Knaapen, Paul, van Royen, Niels, Escaned, Javier, Koo, Bon Kwon, Chamuleau, Steven A J, Kakuta, Tsunekazu, Piek, Jan J, and Christiansen, Evald Høj
Published: 2023

4. Microvascular resistance reserve: diagnostic and prognostic performance in the ILIAS registry

Author: Team Medisch, Boerhout, Coen K M, Lee, Joo Myung, de Waard, Guus A, Mejia-Renteria, Hernan, Lee, Seung Hun, Jung, Ji-Hyun, Hoshino, Masahiro, Echavarria-Pinto, Mauro, Meuwissen, Martijn, Matsuo, Hitoshi, Madera-Cambero, Maribel, Eftekhari, Ashkan, Effat, Mohamed A, Murai, Tadashi, Marques, Koen, Doh, Joon-Hyung, Christiansen, Evald H, Banerjee, Rupak, Nam, Chang-Wook, Niccoli, Giampaolo, Nakayama, Masafumi, Tanaka, Nobuhiro, Shin, Eun-Seok, Appelman, Yolande, Beijk, Marcel A M, van Royen, Niels, Knaapen, Paul, Escaned, Javier, Kakuta, Tsunekazu, Koo, Bon Kwon, Piek, Jan J, van de Hoef, Tim P, Team Medisch, Boerhout, Coen K M, Lee, Joo Myung, de Waard, Guus A, Mejia-Renteria, Hernan, Lee, Seung Hun, Jung, Ji-Hyun, Hoshino, Masahiro, Echavarria-Pinto, Mauro, Meuwissen, Martijn, Matsuo, Hitoshi, Madera-Cambero, Maribel, Eftekhari, Ashkan, Effat, Mohamed A, Murai, Tadashi, Marques, Koen, Doh, Joon-Hyung, Christiansen, Evald H, Banerjee, Rupak, Nam, Chang-Wook, Niccoli, Giampaolo, Nakayama, Masafumi, Tanaka, Nobuhiro, Shin, Eun-Seok, Appelman, Yolande, Beijk, Marcel A M, van Royen, Niels, Knaapen, Paul, Escaned, Javier, Kakuta, Tsunekazu, Koo, Bon Kwon, Piek, Jan J, and van de Hoef, Tim P
Published: 2023

5. Sex differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome in symptomatic patients undergoing invasive coronary angiography: Insights from the global ILIAS invasive coronary physiology registry

Author: Team Medisch, Vink, Caitlin E M, Woudstra, Janneke, Lee, Joo Myung, Boerhout, Coen K M, Cook, Christopher M, Hoshino, Masahiro, Mejia-Renteria, Hernan, Lee, Seung Hun, Jung, Ji-Hyun, Echavarria-Pinto, Mauro, Meuwissen, Martijn, Matsuo, Hitoshi, Madera-Cambero, Maribel, Eftekhari, Ashkan, Effat, Mohamed A, Murai, Tadashi, Marques, Koen, Beijk, Marcel A M, Doh, Joon-Hyung, Piek, Jan J, van de Hoef, Tim P, Christiansen, Evald Høj, Banerjee, Rupak, Nam, Chang-Wook, Niccoli, Giampaolo, Nakayama, Masafumi, Tanaka, Nobuhiro, Shin, Eun-Seok, van Royen, Niels, Chamuleau, Steven A J, Knaapen, Paul, Escaned, Javier, Kakuta, Tsunekazu, Koo, Bon-Kwon, Appelman, Yolande, de Waard, Guus A, Team Medisch, Vink, Caitlin E M, Woudstra, Janneke, Lee, Joo Myung, Boerhout, Coen K M, Cook, Christopher M, Hoshino, Masahiro, Mejia-Renteria, Hernan, Lee, Seung Hun, Jung, Ji-Hyun, Echavarria-Pinto, Mauro, Meuwissen, Martijn, Matsuo, Hitoshi, Madera-Cambero, Maribel, Eftekhari, Ashkan, Effat, Mohamed A, Murai, Tadashi, Marques, Koen, Beijk, Marcel A M, Doh, Joon-Hyung, Piek, Jan J, van de Hoef, Tim P, Christiansen, Evald Høj, Banerjee, Rupak, Nam, Chang-Wook, Niccoli, Giampaolo, Nakayama, Masafumi, Tanaka, Nobuhiro, Shin, Eun-Seok, van Royen, Niels, Chamuleau, Steven A J, Knaapen, Paul, Escaned, Javier, Kakuta, Tsunekazu, Koo, Bon-Kwon, Appelman, Yolande, and de Waard, Guus A
Published: 2023

6. Age‐related changes in the coronary microcirculation influencing the diagnostic performance of invasive pressure‐based indices and long‐term patient prognosis

Author: Faria, Daniel, Mejía Rentería, Hernán David, Lee, Joo Myung, Lee, Seung Hun, Travieso, Alejandro, Jung, Ji‐Hyun, Doh, Joon Hyung, Nam, Chang Wook, Shin, Eun Seok, Hoshino, Masahiro, Sugiyama, Tomoyo, Kanaji, Yoshihisa, Gonzalo, Nieves, Kakuta, Tsunekazu, Koo, Bon Kwon, Escaned, Javier, Faria, Daniel, Mejía Rentería, Hernán David, Lee, Joo Myung, Lee, Seung Hun, Travieso, Alejandro, Jung, Ji‐Hyun, Doh, Joon Hyung, Nam, Chang Wook, Shin, Eun Seok, Hoshino, Masahiro, Sugiyama, Tomoyo, Kanaji, Yoshihisa, Gonzalo, Nieves, Kakuta, Tsunekazu, Koo, Bon Kwon, and Escaned, Javier
Abstract: CRUE-CSIC (Acuerdos Transformativos 2022), Objectives Investigate age-related changes in coronary microvascular function, its effect on hyperemic and non-hyperemic indices of stenosis relevance, and its prognostic implications. Background Evidence assessing the effect of age on fractional flow reserve (FFR), resting mean distal intracoronary pressure/mean aortic pressure (Pd/Pa), and microcirculatory function remains scarce. Methods This is a post hoc study of a large prospective international registry (NCT03690713) including 1134 patients (1326 vessels) with coronary stenoses interrogated with pressure and flow guidewires. Age-dependent correlations with functional indices were analyzed. Prevalences of FFR, resting Pd/Pa, and coronary flow reserve (CFR) classification agreement were assessed. At 5 years follow-up, the relation between resting Pd/Pa, CFR, and their age-dependent implications on FFR-guided percutaneous coronary intervention (PCI) deferral (deferred if FFR > 0.80) were investigated using vessel-oriented composite outcomes (VOCO) composed of death, myocardial infarction, and repeated revascularization. Results Age correlated positively with FFR (r = 0.08, 95% confidence interval [CI]: 0.03 to 0.13, p = 0.005), but not with resting Pd/Pa (r = −0.03, 95% CI:−0.09 to 0.02, p = 0.242). CFR correlated negatively with age (r = −0.15, 95% CI: −0.21 to −0.10, p < 0.001) due to a significant decrease in maximal hyperemic flow in older patients. Patients over 60 years of age with FFR-guided deferred-PCI abnormal resting Pd/Pa or abnormal CFR had increased risk of VOCO (hazard ratio [HR]: 2.10, 95% CI: 1.15 to 4.36, p = 0.048; HR: 2.46, 95% CI:1.23 to 4.96, p = 0.011; respectively). Conlusions Aging is associated with decrease in microcirculatory vasodilation, as assessed with adenosine-based methods like CFR. In patients older than 60 years in whom PCI is deferred according to FFR > 0.80, CFR and resting Pd/Pa have an incremental value in predicting future vessel-oriented patient outcomes., Depto. de Medicina, Fac. de Medicina, TRUE, pub
Published: 2022

7. Prognostic Implications of Fractional Flow Reserve After Coronary Stenting:A Systematic Review and Meta-analysis

Author: Hwang, Doyeon, Koo, Bon Kwon, Zhang, Jinlong, Park, Jiesuck, Yang, Seokhun, Kim, Minsang, Yun, Jun Pil, Lee, Joo Myung, Nam, Chang Wook, Shin, Eun Seok, Doh, Joon Hyung, Chen, Shao Liang, Kakuta, Tsunekazu, Toth, Gabor G., Piroth, Zsolt, Johnson, Nils P., Pijls, Nico H.J., Hakeem, Abdul, Uretsky, Barry F., Hokama, Yohei, Tanaka, Nobuhiro, Lim, Hong Seok, Ito, Tsuyoshi, Matsuo, Akiko, Azzalini, Lorenzo, Leesar, Massoud A., Neleman, Tara, van Mieghem, Nicolas M., Diletti, Roberto, Daemen, Joost, Collison, Damien, Collet, Carlos, De Bruyne, Bernard, Hwang, Doyeon, Koo, Bon Kwon, Zhang, Jinlong, Park, Jiesuck, Yang, Seokhun, Kim, Minsang, Yun, Jun Pil, Lee, Joo Myung, Nam, Chang Wook, Shin, Eun Seok, Doh, Joon Hyung, Chen, Shao Liang, Kakuta, Tsunekazu, Toth, Gabor G., Piroth, Zsolt, Johnson, Nils P., Pijls, Nico H.J., Hakeem, Abdul, Uretsky, Barry F., Hokama, Yohei, Tanaka, Nobuhiro, Lim, Hong Seok, Ito, Tsuyoshi, Matsuo, Akiko, Azzalini, Lorenzo, Leesar, Massoud A., Neleman, Tara, van Mieghem, Nicolas M., Diletti, Roberto, Daemen, Joost, Collison, Damien, Collet, Carlos, and De Bruyne, Bernard
Abstract: Importance: Fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is generally considered to reflect residual disease. Yet the clinical relevance of post-PCI FFR after drug-eluting stent (DES) implantation remains unclear. Objective: To evaluate the clinical relevance of post-PCI FFR measurement after DES implantation. Data Sources: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant published articles from inception to June 18, 2022. Study Selection: Published articles that reported post-PCI FFR after DES implantation and its association with clinical outcomes were included. Data Extraction and Synthesis: Patient-level data were collected from the corresponding authors of 17 cohorts using a standardized spreadsheet. Meta-estimates for primary and secondary outcomes were analyzed per patient and using mixed-effects Cox proportional hazard regression with registry identifiers included as a random effect. All processes followed the Preferred Reporting Items for Systematic Review and Meta-analysis of Individual Participant Data. Main Outcomes and Measures: The primary outcome was target vessel failure (TVF) at 2 years, a composite of cardiac death, target vessel myocardial infarction (TVMI), and target vessel revascularization (TVR). The secondary outcome was a composite of cardiac death or TVMI at 2 years. Results: Of 2268 articles identified, 29 studies met selection criteria. Of these, 28 articles from 17 cohorts provided data, including a total of 5277 patients with 5869 vessels who underwent FFR measurement after DES implantation. Mean (SD) age was 64.4 (10.1) years and 4141 patients (78.5%) were men. Median (IQR) post-PCI FFR was 0.89 (0.84-0.94) and 690 vessels (11.8%) had a post-PCI FFR of 0.80 or below. The cumulative incidence of TVF was 340 patients (7.2%), with cardiac death or TVMI occurring in 111 patients (2.4%) at 2 years. Lower post-PCI FFR significantly increased the risk of TVF
Published: 2022

8. The effect of scan and patient parameters on the diagnostic performance of AI for detecting coronary stenosis on coronary CT angiography

Author: Jonas, Rebecca, Barkovich, Emil, Choi, Andrew D, Griffin, William F, Riess, Joanna, Marques, Hugo, Chang, Hyuk-Jae, Choi, Jung Hyun, Doh, Joon-Hyung, Her, Ae-Young, Koo, Bon-Kwon, Nam, Chang-Wook, Park, Hyung-Bok, Shin, Sang-Hoon, Cole, Jason, Gimelli, Alessia, Khan, Muhammad Akram, Lu, Bin, Gao, Yang, Nabi, Faisal, Nakazato, Ryo, Schoepf, U Joseph, Driessen, Roel S, Bom, Michiel J, Thompson, Randall C, Jang, James J, Ridner, Michael, Rowan, Chris, Avelar, Erick, Généreux, Philippe, Knaapen, Paul, de Waard, Guus A, Pontone, Gianluca, Andreini, Daniele, Guglielmo, Marco, Al-Mallah, Mouaz H, Jennings, Robert S, Crabtree, Tami R, Earls, James P, Jonas, Rebecca, Barkovich, Emil, Choi, Andrew D, Griffin, William F, Riess, Joanna, Marques, Hugo, Chang, Hyuk-Jae, Choi, Jung Hyun, Doh, Joon-Hyung, Her, Ae-Young, Koo, Bon-Kwon, Nam, Chang-Wook, Park, Hyung-Bok, Shin, Sang-Hoon, Cole, Jason, Gimelli, Alessia, Khan, Muhammad Akram, Lu, Bin, Gao, Yang, Nabi, Faisal, Nakazato, Ryo, Schoepf, U Joseph, Driessen, Roel S, Bom, Michiel J, Thompson, Randall C, Jang, James J, Ridner, Michael, Rowan, Chris, Avelar, Erick, Généreux, Philippe, Knaapen, Paul, de Waard, Guus A, Pontone, Gianluca, Andreini, Daniele, Guglielmo, Marco, Al-Mallah, Mouaz H, Jennings, Robert S, Crabtree, Tami R, and Earls, James P
Abstract: Objectives: To determine whether coronary computed tomography angiography (CCTA) scanning, scan preparation, contrast, and patient based parameters influence the diagnostic performance of an artificial intelligence (AI) based analysis software for identifying coronary lesions with ≥50% stenosis. Background: CCTA is a noninvasive imaging modality that provides diagnostic and prognostic benefit to patients with coronary artery disease (CAD). The use of AI enabled quantitative CCTA (AI-QCT) analysis software enhances our diagnostic and prognostic ability, however, it is currently unclear whether software performance is influenced by CCTA scanning parameters. Methods: CCTA and quantitative coronary CT (QCT) data from 303 stable patients (64 ± 10 years, 71% male) from the derivation arm of the CREDENCE Trial were retrospectively analyzed using an FDA-cleared cloud-based software that performs AI-enabled coronary segmentation, lumen and vessel wall determination, plaque quantification and characterization, and stenosis determination. The algorithm's diagnostic performance measures (sensitivity, specificity, and accuracy) for detecting coronary lesions of ≥50% stenosis were determined based on concordance with QCA measurements and subsequently compared across scanning parameters (including scanner vendor, model, single vs dual source, tube voltage, dose length product, gating technique, timing method), scan preparation technique (use of beta blocker, use and dose of nitroglycerin), contrast administration parameters (contrast type, infusion rate, iodine concentration, contrast volume) and patient parameters (heart rate and BMI). Results: Within the patient cohort, 13% demonstrated ≥50% stenosis in 3 vessel territories, 21% in 2 vessel territories, 35% in 1 vessel territory while 32% had <50% stenosis in all vessel territories evaluated by QCA. Average AI analysis time was 10.3 ± 2.7 min. On a per vessel basis, there were significant differences only in sensitivity for ≥50%
Published: 2022

9. Relationship of age, atherosclerosis and angiographic stenosis using artificial intelligence

Author: Jonas, Rebecca, Earls, James, Marques, Hugo, Chang, Hyuk-Jae, Choi, Jung Hyun, Doh, Joon-Hyung, Her, Ae-Young, Koo, Bon Kwon, Nam, Chang-Wook, Park, Hyung-Bok, Shin, Sanghoon, Cole, Jason, Gimelli, Alessia, Khan, Muhammad Akram, Lu, Bin, Gao, Yang, Nabi, Faisal, Nakazato, Ryo, Schoepf, U Joseph, Driessen, Roel S, Bom, Michiel J, Thompson, Randall C, Jang, James J, Ridner, Michael, Rowan, Chris, Avelar, Erick, Généreux, Philippe, Knaapen, Paul, de Waard, Guus A, Pontone, Gianluca, Andreini, Daniele, Al-Mallah, Mouaz H, Jennings, Robert, Crabtree, Tami R, Villines, Todd C, Min, James K, Choi, Andrew D, Jonas, Rebecca, Earls, James, Marques, Hugo, Chang, Hyuk-Jae, Choi, Jung Hyun, Doh, Joon-Hyung, Her, Ae-Young, Koo, Bon Kwon, Nam, Chang-Wook, Park, Hyung-Bok, Shin, Sanghoon, Cole, Jason, Gimelli, Alessia, Khan, Muhammad Akram, Lu, Bin, Gao, Yang, Nabi, Faisal, Nakazato, Ryo, Schoepf, U Joseph, Driessen, Roel S, Bom, Michiel J, Thompson, Randall C, Jang, James J, Ridner, Michael, Rowan, Chris, Avelar, Erick, Généreux, Philippe, Knaapen, Paul, de Waard, Guus A, Pontone, Gianluca, Andreini, Daniele, Al-Mallah, Mouaz H, Jennings, Robert, Crabtree, Tami R, Villines, Todd C, Min, James K, and Choi, Andrew D
Abstract: Objective: The study evaluates the relationship of coronary stenosis, atherosclerotic plaque characteristics (APCs) and age using artificial intelligence enabled quantitative coronary computed tomographic angiography (AI-QCT). Methods: This is a post-hoc analysis of data from 303 subjects enrolled in the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial who were referred for invasive coronary angiography and subsequently underwent coronary computed tomographic angiography (CCTA). In this study, a blinded core laboratory analysing quantitative coronary angiography images classified lesions as obstructive (≥50%) or non-obstructive (<50%) while AI software quantified APCs including plaque volume (PV), low-density non-calcified plaque (LD-NCP), non-calcified plaque (NCP), calcified plaque (CP), lesion length on a per-patient and per-lesion basis based on CCTA imaging. Plaque measurements were normalised for vessel volume and reported as % percent atheroma volume (%PAV) for all relevant plaque components. Data were subsequently stratified by age <65 and ≥65 years. Results: The cohort was 64.4±10.2 years and 29% women. Overall, patients >65 had more PV and CP than patients <65. On a lesion level, patients >65 had more CP than younger patients in both obstructive (29.2 mm3 vs 48.2 mm3; p<0.04) and non-obstructive lesions (22.1 mm3 vs 49.4 mm3; p<0.004) while younger patients had more %PAV (LD-NCP) (1.5% vs 0.7%; p<0.038). Younger patients had more PV, LD-NCP, NCP and lesion lengths in obstructive compared with non-obstructive lesions. There were no differences observed between lesion types in older patients. Conclusion: AI-QCT identifies a unique APC signature that differs by age and degree of stenosis and provides a foundation for AI-guided age-based approaches to atherosclerosis identification, prevention and treatment.
Published: 2021

10. Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment.

Author: Sen, Sayan, Sen, Sayan, Ahmad, Yousif, Dehbi, Hakim-Moulay, Howard, James P, Iglesias, Juan F, Al-Lamee, Rasha, Petraco, Ricardo, Nijjer, Sukhjinder, Bhindi, Ravinay, Lehman, Sam, Walters, Darren, Sapontis, James, Janssens, Luc, Vrints, Christiaan J, Khashaba, Ahmed, Laine, Mika, Van Belle, Eric, Krackhardt, Florian, Bojara, Waldemar, Going, Olaf, Härle, Tobias, Indolfi, Ciro, Niccoli, Giampaolo, Ribichini, Flavio, Tanaka, Nobuhiro, Yokoi, Hiroyoshi, Takashima, Hiroaki, Kikuta, Yuetsu, Erglis, Andrejs, Vinhas, Hugo, Silva, Pedro Canas, Baptista, Sérgio B, Alghamdi, Ali, Hellig, Farrel, Koo, Bon-Kwon, Nam, Chang-Wook, Shin, Eun-Seok, Doh, Joon-Hyung, Brugaletta, Salvatore, Alegria-Barrero, Eduardo, Meuwissen, Martijin, Piek, Jan J, van Royen, Niels, Sezer, Murat, Di Mario, Carlo, Gerber, Robert T, Malik, Iqbal S, Sharp, Andrew SP, Talwar, Suneel, Tang, Kare, Samady, Habib, Altman, John, Seto, Arnold H, Singh, Jasvindar, Jeremias, Allen, Matsuo, Hitoshi, Kharbanda, Rajesh K, Patel, Manesh R, Serruys, Patrick, Escaned, Javier, Davies, Justin E, Sen, Sayan, Sen, Sayan, Ahmad, Yousif, Dehbi, Hakim-Moulay, Howard, James P, Iglesias, Juan F, Al-Lamee, Rasha, Petraco, Ricardo, Nijjer, Sukhjinder, Bhindi, Ravinay, Lehman, Sam, Walters, Darren, Sapontis, James, Janssens, Luc, Vrints, Christiaan J, Khashaba, Ahmed, Laine, Mika, Van Belle, Eric, Krackhardt, Florian, Bojara, Waldemar, Going, Olaf, Härle, Tobias, Indolfi, Ciro, Niccoli, Giampaolo, Ribichini, Flavio, Tanaka, Nobuhiro, Yokoi, Hiroyoshi, Takashima, Hiroaki, Kikuta, Yuetsu, Erglis, Andrejs, Vinhas, Hugo, Silva, Pedro Canas, Baptista, Sérgio B, Alghamdi, Ali, Hellig, Farrel, Koo, Bon-Kwon, Nam, Chang-Wook, Shin, Eun-Seok, Doh, Joon-Hyung, Brugaletta, Salvatore, Alegria-Barrero, Eduardo, Meuwissen, Martijin, Piek, Jan J, van Royen, Niels, Sezer, Murat, Di Mario, Carlo, Gerber, Robert T, Malik, Iqbal S, Sharp, Andrew SP, Talwar, Suneel, Tang, Kare, Samady, Habib, Altman, John, Seto, Arnold H, Singh, Jasvindar, Jeremias, Allen, Matsuo, Hitoshi, Kharbanda, Rajesh K, Patel, Manesh R, Serruys, Patrick, Escaned, Javier, and Davies, Justin E
Abstract: BackgroundPhysicians are not always comfortable deferring treatment of a stenosis in the left anterior descending (LAD) artery because of the perception that there is a high risk of major adverse cardiac events (MACE). The authors describe, using the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) trial, MACE rates when LAD lesions are deferred, guided by physiological assessment using fractional flow reserve (FFR) or the instantaneous wave-free ratio (iFR).ObjectivesThe purpose of this study was to establish the safety of deferring treatment in the LAD using FFR or iFR within the DEFINE-FLAIR trial.MethodsMACE rates at 1 year were compared between groups (iFR and FFR) in patients whose physiological assessment led to LAD lesions being deferred. MACE was defined as a composite of cardiovascular death, myocardial infarction (MI), and unplanned revascularization at 1 year. Patients, and staff performing follow-up, were blinded to whether the decision was made with FFR or iFR. Outcomes were adjusted for age and sex.ResultsA total of 872 patients had lesions deferred in the LAD (421 guided by FFR, 451 guided by iFR). The event rate with iFR was significantly lower than with FFR (2.44% vs. 5.26%; adjusted HR: 0.46; 95% confidence interval [CI]: 0.22 to 0.95; p = 0.04). This was driven by significantly lower unplanned revascularization with iFR and numerically lower MI (unplanned revascularization: 2.22% iFR vs. 4.99% FFR; adjusted HR: 0.44; 95% CI: 0.21 to 0.93; p = 0.03; MI: 0.44% iFR vs. 2.14% FFR; adjusted HR: 0.23; 95% CI: 0.05 to 1.07; p = 0.06).ConclusionsiFR-guided deferral appears to be safe for patients with LAD lesions. Patients in whom iFR-guided deferral was performed had statistically significantly lower event rates than those with FFR-guided deferral.
Published: 2019

11. Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment.

Author: Sen, Sayan, Sen, Sayan, Ahmad, Yousif, Dehbi, Hakim-Moulay, Howard, James P, Iglesias, Juan F, Al-Lamee, Rasha, Petraco, Ricardo, Nijjer, Sukhjinder, Bhindi, Ravinay, Lehman, Sam, Walters, Darren, Sapontis, James, Janssens, Luc, Vrints, Christiaan J, Khashaba, Ahmed, Laine, Mika, Van Belle, Eric, Krackhardt, Florian, Bojara, Waldemar, Going, Olaf, Härle, Tobias, Indolfi, Ciro, Niccoli, Giampaolo, Ribichini, Flavio, Tanaka, Nobuhiro, Yokoi, Hiroyoshi, Takashima, Hiroaki, Kikuta, Yuetsu, Erglis, Andrejs, Vinhas, Hugo, Silva, Pedro Canas, Baptista, Sérgio B, Alghamdi, Ali, Hellig, Farrel, Koo, Bon-Kwon, Nam, Chang-Wook, Shin, Eun-Seok, Doh, Joon-Hyung, Brugaletta, Salvatore, Alegria-Barrero, Eduardo, Meuwissen, Martijin, Piek, Jan J, van Royen, Niels, Sezer, Murat, Di Mario, Carlo, Gerber, Robert T, Malik, Iqbal S, Sharp, Andrew SP, Talwar, Suneel, Tang, Kare, Samady, Habib, Altman, John, Seto, Arnold H, Singh, Jasvindar, Jeremias, Allen, Matsuo, Hitoshi, Kharbanda, Rajesh K, Patel, Manesh R, Serruys, Patrick, Escaned, Javier, Davies, Justin E, Sen, Sayan, Sen, Sayan, Ahmad, Yousif, Dehbi, Hakim-Moulay, Howard, James P, Iglesias, Juan F, Al-Lamee, Rasha, Petraco, Ricardo, Nijjer, Sukhjinder, Bhindi, Ravinay, Lehman, Sam, Walters, Darren, Sapontis, James, Janssens, Luc, Vrints, Christiaan J, Khashaba, Ahmed, Laine, Mika, Van Belle, Eric, Krackhardt, Florian, Bojara, Waldemar, Going, Olaf, Härle, Tobias, Indolfi, Ciro, Niccoli, Giampaolo, Ribichini, Flavio, Tanaka, Nobuhiro, Yokoi, Hiroyoshi, Takashima, Hiroaki, Kikuta, Yuetsu, Erglis, Andrejs, Vinhas, Hugo, Silva, Pedro Canas, Baptista, Sérgio B, Alghamdi, Ali, Hellig, Farrel, Koo, Bon-Kwon, Nam, Chang-Wook, Shin, Eun-Seok, Doh, Joon-Hyung, Brugaletta, Salvatore, Alegria-Barrero, Eduardo, Meuwissen, Martijin, Piek, Jan J, van Royen, Niels, Sezer, Murat, Di Mario, Carlo, Gerber, Robert T, Malik, Iqbal S, Sharp, Andrew SP, Talwar, Suneel, Tang, Kare, Samady, Habib, Altman, John, Seto, Arnold H, Singh, Jasvindar, Jeremias, Allen, Matsuo, Hitoshi, Kharbanda, Rajesh K, Patel, Manesh R, Serruys, Patrick, Escaned, Javier, and Davies, Justin E
Abstract: BackgroundPhysicians are not always comfortable deferring treatment of a stenosis in the left anterior descending (LAD) artery because of the perception that there is a high risk of major adverse cardiac events (MACE). The authors describe, using the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) trial, MACE rates when LAD lesions are deferred, guided by physiological assessment using fractional flow reserve (FFR) or the instantaneous wave-free ratio (iFR).ObjectivesThe purpose of this study was to establish the safety of deferring treatment in the LAD using FFR or iFR within the DEFINE-FLAIR trial.MethodsMACE rates at 1 year were compared between groups (iFR and FFR) in patients whose physiological assessment led to LAD lesions being deferred. MACE was defined as a composite of cardiovascular death, myocardial infarction (MI), and unplanned revascularization at 1 year. Patients, and staff performing follow-up, were blinded to whether the decision was made with FFR or iFR. Outcomes were adjusted for age and sex.ResultsA total of 872 patients had lesions deferred in the LAD (421 guided by FFR, 451 guided by iFR). The event rate with iFR was significantly lower than with FFR (2.44% vs. 5.26%; adjusted HR: 0.46; 95% confidence interval [CI]: 0.22 to 0.95; p = 0.04). This was driven by significantly lower unplanned revascularization with iFR and numerically lower MI (unplanned revascularization: 2.22% iFR vs. 4.99% FFR; adjusted HR: 0.44; 95% CI: 0.21 to 0.93; p = 0.03; MI: 0.44% iFR vs. 2.14% FFR; adjusted HR: 0.23; 95% CI: 0.05 to 1.07; p = 0.06).ConclusionsiFR-guided deferral appears to be safe for patients with LAD lesions. Patients in whom iFR-guided deferral was performed had statistically significantly lower event rates than those with FFR-guided deferral.
Published: 2019

12. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to
Published: 2018
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13. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to
Published: 2018
Full Text: View/download PDF

14. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to
Published: 2018
Full Text: View/download PDF

15. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to
Published: 2018
Full Text: View/download PDF

16. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to
Published: 2018
Full Text: View/download PDF

17. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to
Published: 2018
Full Text: View/download PDF

18. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p amp;lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used, Funding Agencies|Philips; Upsala Clinical Research Centre; Volcano; Imperial College; Philips Volcano; Imperial College London; Medical Research Council
Published: 2018
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19. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to
Published: 2018
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20. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p amp;lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used, Funding Agencies|Philips; Upsala Clinical Research Centre; Volcano; Imperial College; Philips Volcano; Imperial College London; Medical Research Council
Published: 2018
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21. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to
Published: 2018
Full Text: View/download PDF

22. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p amp;lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used, Funding Agencies|Philips; Upsala Clinical Research Centre; Volcano; Imperial College; Philips Volcano; Imperial College London; Medical Research Council
Published: 2018
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23. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to
Published: 2018
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24. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p amp;lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used, Funding Agencies|Philips; Upsala Clinical Research Centre; Volcano; Imperial College; Philips Volcano; Imperial College London; Medical Research Council
Published: 2018
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25. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to
Published: 2018
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26. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Author: Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Gotberg, Matthias, Escaned, Javier, Ryan, Nicola, Mejia-Renteria, Hernan, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sergio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jorg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjorg, Haerle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Karegren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S. P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Frobert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., and Gotberg, Matthias
Abstract: OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p amp;lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used, Funding Agencies|Philips; Upsala Clinical Research Centre; Volcano; Imperial College; Philips Volcano; Imperial College London; Medical Research Council
Published: 2018
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27. Automated Quantitative Plaque Burden from Coronary CT Angiography Noninvasively Predicts Hemodynamic Significance by using Fractional Flow Reserve in Intermediate Coronary Lesions.

Author: Diaz-Zamudio, Mariana, Diaz-Zamudio, Mariana, Dey, Damini, Schuhbaeck, Annika, Nakazato, Ryo, Gransar, Heidi, Slomka, Piotr J, Narula, Jagat, Berman, Daniel S, Achenbach, Stephan, Min, James K, Doh, Joon-Hyung, Koo, Bon-Kwon, Diaz-Zamudio, Mariana, Diaz-Zamudio, Mariana, Dey, Damini, Schuhbaeck, Annika, Nakazato, Ryo, Gransar, Heidi, Slomka, Piotr J, Narula, Jagat, Berman, Daniel S, Achenbach, Stephan, Min, James K, Doh, Joon-Hyung, and Koo, Bon-Kwon
Abstract: PurposeTo evaluate the utility of multiple automated plaque measurements from coronary computed tomographic (CT) angiography in determining hemodynamic significance by using invasive fractional flow reserve (FFR) in patients with intermediate coronary stenosis.Materials and methodsThe study was approved by the institutional review board. All patients provided written informed consent. Fifty-six intermediate lesions (with 30%-69% diameter stenosis) in 56 consecutive patients (mean age, 62 years; range, 46-88 years), who subsequently underwent invasive coronary angiography with assessment of FFR (values ≤0.80 were considered hemodynamically significant) were analyzed at coronary CT angiography. Coronary CT angiography images were quantitatively analyzed with automated software to obtain the following measurements: volume and burden (plaque volume × 100 per vessel volume) of total, calcified, and noncalcified plaque; low-attenuation (<30 HU) noncalcified plaque; diameter stenosis; remodeling index; contrast attenuation difference (maximum percent difference in attenuation per unit area with respect to the proximal reference cross section); and lesion length. Logistic regression adjusted for potential confounding factors, receiver operating characteristics, and integrated discrimination improvement were used for statistical analysis.ResultsFFR was 0.80 or less in 21 (38%) of the 56 lesions. Compared with nonischemic lesions, ischemic lesions had greater diameter stenosis (65% vs 52%, P = .02) and total (49% vs 37%, P = .0003), noncalcified (44% vs 33%, P = .0004), and low-attenuation noncalcified (9% vs 4%, P < .0001) plaque burden. Calcified plaque and remodeling index were not significantly different. In multivariable analysis, only total, noncalcified, and low-attenuation noncalcified plaque burden were significant predictors of ischemia (P < .015). For predicting ischemia, the area under the receiver operating characteristics curve was 0.83 for total plaque
Published: 2015

28. Efficacy of fimasartan/hydrochlorothiazide combination in hypertensive patients inadequately controlled by fimasartan monotherapy

Author: Rhee,Moo-Yong, Baek,Sang Hong, Kim,Weon, Park,Chang Gyu, Park,Seung Woo, Oh,Byung-Hee, Kim,Sang-Hyun, Kim,Jae-Joong, Shin,Joon-Han, Yoo,Byung-Su, Rim,Se-Joong, Ha,Jong-Won, Doh,Joon Hyung, Ahn,Youngkeun, Chae,Jei Keon, Park,Jeong Bae, Kim,Soon-Kil, Kim,Cheol Ho, Rhee,Moo-Yong, Baek,Sang Hong, Kim,Weon, Park,Chang Gyu, Park,Seung Woo, Oh,Byung-Hee, Kim,Sang-Hyun, Kim,Jae-Joong, Shin,Joon-Han, Yoo,Byung-Su, Rim,Se-Joong, Ha,Jong-Won, Doh,Joon Hyung, Ahn,Youngkeun, Chae,Jei Keon, Park,Jeong Bae, Kim,Soon-Kil, and Kim,Cheol Ho
Abstract: Moo-Yong Rhee,1 Sang Hong Baek,2 Weon Kim,3 Chang Gyu Park,4 Seung Woo Park,5 Byung-Hee Oh,6 Sang-Hyun Kim,7 Jae-Joong Kim,8 Joon-Han Shin,9 Byung-Su Yoo,10 Se-Joong Rim,11 Jong-Won Ha,12 Joon Hyung Doh,13 Youngkeun Ahn,14 Jei Keon Chae,15 Jeong Bae Park,16 Soon-Kil Kim,17 Cheol Ho Kim18 1Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, 2Catholic University of Korea, Seoul St Mary’s Hospital, Seoul, 3Cardiovascular Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, 4Division of Cardiology, Guro Hospital, Korea University College of Medicine, Seoul, 5Division of Cardiology, Samsung Medical Center, Seoul, 6Department of Internal Medicine, Seoul National University Hospital, Seoul, 7Division of Cardiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, 8Division of Cardiology, Asan Medical Center, Seoul, 9Division of Cardiology, Ajou University Hospital, Suwon, 10Division of Cardiology, Wonju Severance Christian Hospital, Wonju, 11Division of Cardiology, GangNam Severance Hospital, Seoul, 12Division of Cardiology, Severance Hospital, Seoul, 13Division of Cardiology, Inje University Ilsan Hospital, Goyang, 14Department of Cardiology, Chonnam National University Hospital, Gwangju, 15Chonbuk National University Hospital, Jeonju, 16Department of Cardiology, Cheil General Hospital, Dankook University College of Medicine, Seoul, 17Department of Cardiology, Hanyang University Guri Hospital, Guri, 18Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea Background: The study reported here compared the blood pressure (BP)-lowering efficacy of fimasartan alone with that of fimasartan/hydrochlorothiazide (HCTZ) combination in patients whose BP goal was not achieved after 4 weeks of treatment with once-daily fimasartan 60 mg.Methods: Patients with sitting diastolic blood pressure (siDBP) ≥90 mmHg with 4 wee
Published: 2015

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28 results on '"Doh, Joon-Hyung"'

1. Impact of sex on the assessment of the microvascular resistance reserve

2. Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications

3. Changes in microvascular resistance following percutaneous coronary intervention - From the ILIAS global registry

4. Microvascular resistance reserve: diagnostic and prognostic performance in the ILIAS registry

5. Sex differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome in symptomatic patients undergoing invasive coronary angiography: Insights from the global ILIAS invasive coronary physiology registry

6. Age‐related changes in the coronary microcirculation influencing the diagnostic performance of invasive pressure‐based indices and long‐term patient prognosis

7. Prognostic Implications of Fractional Flow Reserve After Coronary Stenting:A Systematic Review and Meta-analysis

8. The effect of scan and patient parameters on the diagnostic performance of AI for detecting coronary stenosis on coronary CT angiography

9. Relationship of age, atherosclerosis and angiographic stenosis using artificial intelligence

10. Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment.

11. Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment.

12. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

13. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

14. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

15. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

16. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

17. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

18. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

19. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

20. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

21. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

22. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

23. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

24. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

25. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

26. Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

27. Automated Quantitative Plaque Burden from Coronary CT Angiography Noninvasively Predicts Hemodynamic Significance by using Fractional Flow Reserve in Intermediate Coronary Lesions.

28. Efficacy of fimasartan/hydrochlorothiazide combination in hypertensive patients inadequately controlled by fimasartan monotherapy

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