Clinical Decision Making for the Hemodynamic Gray Zone (Ffr 0.75-0.80) and Impact on Long Term Outcomes

Agarwal, Shiv Kumar; Edupuganti, Mohan Mallikarjuna Rao; Almomani, Ahmed; Pothineni, Naga Venkata K.; Payne, Jason; Kasula, Srikanth; Raina, Sameer; Shailesh, Fnu; Uretsky, Barry F.; Hakeem, Abdul

doi:10.1016/s0735-1097(16)30380-1

Cited by 10 publications

(22 citation statements)

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“…9 In contrast, some retrospective studies, including the present study, have shown that PCI compared with medical therapy was associated with better clinical outcomes in patients with gray zone FFR. 13,14 To prove the superiority of PCI compared with medical therapy in patients with gray zone FFR, we are planning a prospective, multicenter randomized study (the COMFORTABLE prospective study, UMIN000031526). The results of this prospective study will settle the controversy of gray zone FFR.…”

Section: Ffr-guided Pcimentioning

confidence: 99%

Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve　― COMFORTABLE Retrospective Study ―

Kubo

Takahata

Terada³

et al. 2018

Circ J

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Background: A fractional flow reserve (FFR) between 0.75 and 0.80 constitutes a "gray zone" for clinical decision-making in coronary artery disease. We compared long-term outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents vs. medical therapy for coronary stenosis with gray zone FFR. Methods and Results: We retrospectively investigated the clinical outcomes of 263 patients with gray zone FFR: 78 patients in the PCI group and 185 patients in the medical therapy group. During a median follow-up of 3.7 years, the frequency of target vessel failure (TVF, defined as a composite of cardiac death, myocardial infarction [MI], or ischemia-driven target vessel revascularization [TVR]) was significantly lower in the PCI group compared with the medical therapy group (6% vs. 19%, hazard ratio [HR]:0.33, 95% confidence interval [CI]: 0.13-0.84, P=0.008). The frequency of a composite of cardiac death or MI was not different between the 2 groups (1% vs. 2%, HR: 0.61, 95% CI: 0.07-5.49, P=0.645). The frequency of ischemia-driven TVR was significantly lower in the PCI group compared with the medical therapy group (5% vs. 18%, HR: 0.28, 95% CI: 0.10-0.79, P=0.005). Conclusions: In patients with gray zone FFR, compared with medical therapy, PCI decreased the frequency of TVF, which was mainly driven by a reduction in the frequency of angina or myocardial ischemia without any difference in the frequency of cardiac death or MI.

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Section: Ffr-guided Pcimentioning

confidence: 99%

Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve　― COMFORTABLE Retrospective Study ―

Kubo

Takahata

Terada³

et al. 2018

Circ J

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“…This, however, creates a "gray-zone" of FFR values in this 0.75-0.80 gap, with unclear clinical significance. The benefit of revascularization in this threshold group has not reached consensus [59][60][61].…”

Section: Fractional Flow Reservementioning

confidence: 99%

Determining the Significance of Coronary Plaque Lesions: Physiological Stenosis Severity and Plaque Characteristics

Clarke

Lau

Zarich

2020

JCM

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The evaluation of coronary lesions has evolved in recent years. Physiologic-guided revascularization (particularly with pressure-derived fractional flow reserve (FFR)) has led to superior outcomes compared to traditional angiographic assessment. A greater importance, therefore, has been placed on the functional significance of an epicardial lesion. Despite the improvements in the limitations of angiography, insights into the relationship between hemodynamic significance and plaque morphology at the lesion level has shown that determining the implications of epicardial lesions is rather complex. Investigators have sought greater understanding by correlating ischemia quantified by FFR with plaque characteristics determined on invasive and non-invasive modalities. We review the background of the use of these diagnostic tools in coronary artery disease and discuss the implications of analyzing physiological stenosis severity and plaque characteristics concurrently.

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“…The clinical significance of FFR values in this 0.75-0.80 gap therefore generated much attention. The benefit of revascularization in this threshold group unfortunately is inconclusive [40][41][42].…”

Section: Fractional Flow Reserve (Ffr)mentioning

confidence: 99%

“…About every forty (40) seconds, an adult in the United States suffers an acute myocardial infarction (AMI) [1]. Over the last two decades, the standard of care for patients with ST-segment myocardial infarction (STEMI) has been primary percutaneous coronary intervention (P-PCI) within ninety minutes of presentation to an equipped center [2,3].…”

Section: Introductionmentioning

confidence: 99%

Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance

Clarke

Kennedy

Lau

et al. 2019

JCM

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Acute myocardial infarction (AMI) is one of the most common causes of death in both the developed and developing world. It has high associated morbidity despite prompt institution of recommended therapy. The focus over the last few decades in ST-segment elevation AMI has been on timely reperfusion of the epicardial vessel. However, microvascular consequences after reperfusion, such as microvascular obstruction (MVO), are equally reliable predictors of outcome. The attention on the microcirculation has meant that traditional angiographic/anatomic methods are insufficient. We searched PubMed and the Cochrane database for English-language studies published between January 2000 and November 2019 that investigated the use of invasive physiologic tools in AMI. Based on these results, we provide a comprehensive review regarding the role for the invasive evaluation of the microcirculation in AMI, with specific emphasis on coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR).

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Clinical Decision Making for the Hemodynamic Gray Zone (Ffr 0.75-0.80) and Impact on Long Term Outcomes

Cited by 10 publications

References 0 publications

Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve　― COMFORTABLE Retrospective Study ―

Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve　― COMFORTABLE Retrospective Study ―

Determining the Significance of Coronary Plaque Lesions: Physiological Stenosis Severity and Plaque Characteristics

Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance

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Clinical Decision Making for the Hemodynamic Gray Zone (Ffr 0.75-0.80) and Impact on Long Term Outcomes

Cited by 10 publications

References 0 publications

Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve ― COMFORTABLE Retrospective Study ―

Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve ― COMFORTABLE Retrospective Study ―

Determining the Significance of Coronary Plaque Lesions: Physiological Stenosis Severity and Plaque Characteristics

Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance

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Product

Resources

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Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve　― COMFORTABLE Retrospective Study ―

Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve　― COMFORTABLE Retrospective Study ―