Long‐term outcomes of intermediate coronary stenosis in patients undergoing hemodialysis after deferred revascularization based on fractional flow reserve

Abstract

Objectives: This study aimed to assess the long-term outcomes of patients undergoing hemodialysis (HD) after deferred revascularization based on fractional flow reserve (FFR). Background: FFR is a practical technique for assessing the functional severity of intermediate coronary stenosis. Prior research has revealed a satisfactory outcome in patients after the deferral of percutaneous coronary intervention for coronary lesions based on FFR measurement. However, little research has been conducted focusing on patients undergoing HD. Methods: The retrospective study comprised 225 consecutive patients with FFR assessment and deferred revascularization between January 2016 and December 2019. Based on a deferral cutoff FFR value of >0.80, we assessed the differences in all-cause death, major adverse cardiac events (MACEs), and target vessel failure (TVF) between the HD (n = 69) and non-HD groups (n = 156) during a mean ± standard deviation routine follow-up of 32.2 ± 13.4 months.Results: Although the HD group had significantly higher rates of diabetes mellitus than the non-HD group (53.6% vs. 37.2%, p = 0.021), there were no significant differences in sex, left ventricular ejection fraction, or other risk factors between the groups, nor with respect to stenosis diameter or mean FFR.The HD group had a significantly higher incidence of TVF than the non-HD group (34.8% vs. 14.1%, p < 0.001), as well as a significantly higher risk of allcause death and MACEs. Conclusions:The study revealed that deferred revascularization in coronary lesions with an FFR value of >0.80 in patients undergoing HD was associated with poor outcomes. Therefore, it is important to carefully monitor patients with intermediate coronary stenosis undergoing HD.

Practical Application of Coronary Physiologic Assessment

“…Although FFR-guided deferral is generally acceptable, hemodialysis patients who undergo deferral have a 2 to 4 times higher risk of clinical events than nonhemodialysis patients. 45 , 46 Therefore, they require more intensive medical management and meticulous follow-up.…”

Current Issues in Coronary Revascularization for Hemodialysis Patients

“…In addition, Yokoi et al reported that the incidence of MACE after deferral was significantly higher than the incidence of MACE in non-HD patients 45) . The rapid progression of coronary lesions and MVD may underlie these differences between HD and non-HD patients [44][45][46] .…”

The Controversies of Coronary Artery Disease in End-Stage Kidney Disease Patients: A Narrative Review

“…The DEFER trial established that it was safe to defer revascularisation of FFR-negative coronary lesions [ 261 ]. A similar study in HD patients observed significantly higher rates of MACE and target vessel failure (TVF) following deferral of revascularisation (FFR 0.80) [ 279 ]. In a separate study comparing outcomes between FFR-guided revascularisation (FFR 0.80) and non-intervention, functional ischaemia was associated with a poorer prognosis despite revascularisation in pre-dialysis CKD and ESKD patients [ 280 ]…”