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The aim of this study was to evaluate the impact of thrombotic risk on the occurrence of cardiovascular events in patients with coronary artery disease with deferred revascularization after fractional flow reserve (FFR) measurements. Deferral of revascularization on the basis of FFR is generally considered to be safe, but after deferral, some patients have cardiovascular events over time. From J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), 1,263 patients with deferral of revascularization on the basis of FFR were evaluated. The association between thrombotic risk as assessed by CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) thrombotic score and 5-year target vessel failure (TVF) and major adverse cardiac and cerebrovascular events (MACCE) was investigated. FFR and high thrombotic risk (HTR) were associated with increased risk for 5-year TVF (FFR per 0.01-unit decrease: HR: 1.08; 95% CI: 1.05-1.11; P < 0.001; HTR: HR: 2.16; 95% CI: 1.37-3.39; P < 0.001) and MACCE (FFR per 0.01-unit decrease: HR: 1.05; 95% CI: 1.02-1.06; P < 0.001; HTR: HR: 2.11; 95% CI: 1.56-2.84; P = 0.001). Patients with HTR had higher risk for 5-year TVF (HR: 2.30; 95% CI: 1.45-3.66; P < 0.001) and MACCE (HR: 2.34; 95% CI: 1.75-3.13; P < 0.001) than those without HTR, even when they had negative FFR. Assessment of thrombotic risk provides additional prognostic value to FFR in predicting 5-year TVF and MACCE in patients with deferral of revascularization after FFR measurements. (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry; UMIN000014473) [Display omitted] [ABSTRACT FROM AUTHOR]

• We investigated the clinical implication of post-stent fractional flow reserve (FFR). • Inadequate FFR group was significantly associated with high major adverse cardiovascular events (MACE). • Inadequate FFR group affected high incidence of non-target lesion revascularization in MACE. • Post-stent FFR may be a surrogate marker for atherosclerosis in whole of the coronary artery. Adequate improvement in fractional flow reserve (FFR) is not necessarily achieved in some cases of drug-eluting stent (DES) implantation, even when imaging confirms successful placement. We hypothesized that post-stent FFR may be associated with advanced diffuse atherosclerotic condition. We explored the relationships between FFR values after DES implantation (post-stent FFR). A total of 218 patients were included in this prospective, multicenter study and were divided into two groups: adequate FFR group (post-stent FFR >0.80, n =176) and inadequate FFR group (post-stent FFR ≤0.80, n =42). The primary endpoint was a major adverse cardiovascular event (MACE) including cardiac death, non-fatal myocardial infarction (MI), unplanned coronary revascularization, and hospitalization for heart failure. The secondary endpoints were event rate of all-cause death, non-fatal MI, unplanned coronary revascularization, non-fatal stroke, and hospitalization for heart failure. During follow-up of 31.4±8.7 months, 34 patients (16%) had cardiovascular events. Inadequate FFR group was significantly associated with higher risk of MACE (hazard ratio: 3.86; 95% confidence interval: 1.17–12.76, p =0.026; log-rank p =0.027). In particular, the incidence of unplanned coronary revascularization on non-target lesions was significantly higher in the inadequate FFR group (log-rank p =0.031). Post-stent FFR ≤0.80 was associated with a high incidence of non-target lesion revascularization and could be a surrogate marker for advanced atherosclerotic condition in the vessels of the entire coronary artery. [ABSTRACT FROM AUTHOR]

Background: Poststent fractional flow reserve (FFR) is a useful indicator of optimal percutaneous coronary intervention, and higher poststent FFR is associated with favorable long-term clinical outcome. However, little is known about the factors influencing poststent FFR. The purpose of this study was to determine the impact of lesion characteristics on poststent FFR.Methods: For patients who had scheduled stent implantation for stable angina, FFR measurements at maximum hyperemia were performed before and after coronary stent implantation. As one of lesion characteristics, the FFR pressure drop pattern was evaluated and classified as either an abrupt or a gradual pattern according to the pullback curve of FFR.Results: A total of 205 lesions with physiological significant stenosis were evaluated. Fractional flow reserve value increased from 0.67±0.10 to 0.87±0.07 after stent implantation. Optimal poststent FFR was achieved in 75 lesions (36.6%). Logistic regression analysis demonstrated that optimal poststent FFR was positively correlated with an abrupt pressure drop pattern (hazard ratio [HR] 2.11, 95% CI 1.06-4.15, P=.03) and prestent FFR (HR 1.04, 95% CI 1.03-2.04, P=.03; per 0.1 increase), and negatively correlated with lesion localization to the left anterior descending artery (HR 0.18, 95% CI 0.09-0.36, P<.0001). The c statistic for predicting optimal poststent FFR was 0.763 (95% CI 0.702-0.819).Conclusion: Abrupt pressure drop patterns, prestent FFR, and lesion localization to the left anterior descending artery were independent predictors of optimal poststent FFR. [ABSTRACT FROM AUTHOR]

Background Although functional ischemia identification is important when determining revascularization, angiographic assessment alone is challenging in intermediate coronary stenosis. Previous studies have reported that lesion-specific characteristics affected the fractional flow reserve (FFR). However, the relationship between morphological lesion complexity and FFR has not yet been fully evaluated. This study aimed to evaluate the impact of morphological lesion complexity on FFR in intermediate coronary stenosis. Methods A total of 109 consecutive patients with 136 intermediate coronary stenoses (visually estimated diameter stenosis: 40–70%) were assessed via quantitative coronary angiography, lesion-specific characteristics, and FFR. Indexed lesions were assessed according to 6 morphological lesion characteristics: eccentricity, bend, irregularity, calcification, bifurcation, and diffuse. The lesions were then classified into 3 groups according to the morphological severity count represented by the number of present characteristics (mild-complex: 0–1, moderate-complex: 2–3, and severe-complex: 4–6), and their functional severities were evaluated. Lesions with an FFR <0.80 were considered functionally significant coronary stenoses. Results Of the 136 lesions, 51% were located in the left anterior descending artery (LAD) and 47% had an FFR <0.80. The FFR differed significantly among the 3 lesion complexity groups (0.84 ± 0.10 vs. 0.79 ± 0.10 vs. 0.73 ± 0.07, for mild-, moderate-, and severe-complex, respectively; p < 0.01). In a multivariate logistic analysis, LAD lesions, moderate- and severe-complex, and diameter stenosis were independently associated with an FFR <0.80 [odds ratio (OR): 5.65, 95% confidence interval (CI): 2.50–12.80, p < 0.01; OR: 2.96, 95% CI: 1.30–6.72, p < 0.01; OR: 7.11, 95% CI: 1.25–40.37, p = 0.03, and OR: 2.65, 95% CI: 1.04–6.72, p = 0.04, respectively]. Conclusions Both indexed vessels and the degree of diameter stenosis affected the FFR. In addition, the severity of morphological lesion complexity correlated with the degree of functional severity in intermediate coronary stenosis. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to assess the effect of eicosapentaenoic acid (EPA) on peri-procedural (type IVa) myocardial infarction (MI) following elective percutaneous coronary intervention (PCI). Methods and results We analyzed data from 165 of 178 consecutive patients with stable angina pectoris who underwent de novo successful stent implantation in the native coronary artery. Patients were assigned to receive statin therapy in combination with 1800 mg/day of EPA or statin alone. Post-procedural index of microcirculatory resistance (IMR) values were calculated for 30 patients in the EPA group and 32 controls. In the multivariate logistic model, EPA administration, low kidney function, and the presence of slow flow/no reflow were significantly and independently associated with type IVa MI. Post-procedural IMR values were significantly lower in the EPA group [19.8 (6.4, 51.1) vs. 27.8 (8.2, 89.3), p = 0.003] compared to the control group. Conclusions Pre-treatment with EPA in addition to statins significantly reduced the incidence of type IVa MI compared to statin therapy only, which may be attributed to the ability of EPA to reduce microvascular dysfunction induced by PCI. [ABSTRACT FROM AUTHOR]

Background and purpose: Metabolic syndrome (MetS) and chronic kidney disease (CKD) have both been reported as risk factors for cardiovascular events. The aim of this study was to assess the synergistic effect of MetS and CKD on atherosclerotic plaque and cardiovascular outcomes. Methods and subjects: A total of 545 consecutive patients who underwent percutaneous coronary inter-vention (PCI) were divided into 4 groups based on the presence or absence of MetS and CKD. MetS was defined using the criteria of the Adult Treatment Panel III of the US National Cholesterol Education Pro-gram. CKD was defined as an estimated glomerular filtration rate of <60ml/min/1.73m². We analyzed the incidence of major adverse cardiac events (MACE), including cardiovascular death, nonfatal myocar-dial infarction, target lesion revascularization, and revascularization for new lesions. We also assessed coronary plaque characteristics of 204 patients using integrated backscatter intravascular ultrasound (IB-IVUS). Results: MACE occurred more frequently in patients with both MetS and CKD (51.4%) than in the other groups, during the follow-up period (log-rankp < 0.001). In the IB-IVUS analyses, patients with both MetS and CKD exhibited greater plaque burden (p = 0.003) with higher lipid content (p = 0.048) compared to the other groups. In Cox analysis, both MetS and CKD proved to be independent predictors of MACE even after adjustment for confounding factors (p = 0.018). Conclusions: Comorbidity of MetS and CKD is an independent predictor of adverse cardiovascular out-comes in patients undergoing coronary intervention, an effect that may be attributed to coronary plaque instability. [ABSTRACT FROM AUTHOR]

Background: Little large-scale data is available about the long-term (beyond 3 years) clinical outcomes after fractional flow reserve (FFR)-based deferral of revascularization in clinical practice. We sought to assess the 5-year outcomes after deferral of revascularization based on FFR. Methods: The J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry) prospectively enrolled 1263 patients with 1447 lesions in whom revascularization was deferred based on FFR from 28 Japanese centers. The primary study end point was the cumulative 5-year incidence of target vessel failure (TVF), including cardiac death, target vessel-related myocardial infarction, and clinically driven target vessel revascularization. Results: Five-year follow-up was completed in 92.2% of patients. The 5-year TVF rate was 11.6% in deferred lesions, mainly driven by clinically driven target vessel revascularization (9.8%). Cardiac death and target vessel-related myocardial infarction were 1.9% and 0.95%, respectively. Cumulative 5-year incidence of TVF was similar between the FFR 0.75 to 0.80 and 0.81 to 0.85 groups even after adjustment for baseline characteristics (12.2% versus 13.0%, inverse probability-weighted hazard ratio, 0.86 [95% CI, 0.46-1.60]; P =0.63). Compared with the almost normal FFR (0.86-1.00) group, the significant (<0.75) and borderline (0.75-0.85) FFR groups showed a higher incidence of TVF at 5 years (29.9% versus 12.8% versus 8.6%, P <0.001).> Conclusions: The 5-year TVF rate was 11.6% in deferred lesions, mainly driven by clinically driven target vessel revascularization. Notably, cardiac death and target vessel-related myocardial infarction rarely occurred during the follow-up. Our findings highlight the long-term safety of FFR-based deferral of revascularization in patients with chronic coronary syndrome. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000014473. * Previous randomized trials have demonstrated the safety of fractional flow reserve (FFR)-guided deferral of revascularization in patients with chronic coronary syndrome. * However, little large-scale data is available about the longer-term (beyond 3 years) clinical outcomes after FFR-based deferral of revascularization in daily practice. * In patients with chronic coronary syndrome, FFR-guided deferral of revascularization is safe and feasible for up to 5 years in daily practice, which complements previous randomized trials. * Lesions with gray-zone FFR (0.75-0.80) show similar outcomes to those with FFR 0.81 to 0.85 even after adjustment for baseline characteristics. * Compared with lesions with almost normal FFR (0.86-1.00) values, those with significant (<0.75) and borderline (0.75-0.85) FFR values have a higher incidence of target vessel failure at 5 years. [ABSTRACT FROM AUTHOR]

Abstract: Both peri-stent contrast staining (PSS) and late restenosis are abnormal findings after drug-eluting stent implantation and they occur with low incidence. We describe a case with two PSSs and one late restenosis after sirolimus-eluting stent implantation. Persistent high value of C-reactive protein in this patient suggested chronic systematic inflammation as a contributing factor of these abnormal findings. [Copyright &y& Elsevier]

Supplemental Digital Content is available in the text. Background: The safety of fractional flow reserve (FFR)-based deferral of revascularization remains to be fully established in real-world practice. We sought to assess clinical outcomes after deferral of revascularization based on FFR. Methods: The J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry) prospectively enrolled 1263 patients with 1447 lesions in whom revascularization was deferred based on FFR at 28 Japanese centers. The primary study end point was the cumulative 2-year incidence of target vessel failure, including cardiac death, target-vessel related myocardial infarction, and clinically driven target vessel revascularization. Results: The mean FFR was 0.86±0.06. At 2 years, the target vessel failure rate was 5.5% in deferred lesions, mainly driven by a high rate of clinically driven target vessel revascularization (5.2%), and significantly increased with decreasing FFR, especially in the proximal location. Cardiac death and target-vessel related myocardial infarction rarely occurred during the 2-year follow-up (0.41% and 0.41%, respectively). Independent predictors of 2-year target vessel failure were FFR value (per 0.01 decrease; hazard ratio [HR] 1.07 [95% CI, 1.04–1.11], P <0.001), left main coronary artery lesion (HR, 5.89 [95% CI, 2.72–12.8], P <0.001), moderately to severely calcified lesion (HR, 2.49 [95% CI, 1.36–4.58]; P =0.003), hemodialysis (HR, 2.90 [95% CI, 1.11–7.58]; P =0.03), and right coronary artery lesion (HR, 1.78 [95% CI, 1.02–3.11], P =0.042). Conclusions: The J-CONFIRM registry demonstrated the 2-year target vessel failure rate was 5.5% in deferred lesions, highlighting the safety of FFR-based deferral of revascularization in daily practice. Clinical Trial Registration: URL: http://www.umin.ac.jp. Unique identifier: UMIN000014473. [ABSTRACT FROM AUTHOR]