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oai:repisalud.isciii.es:20.500.12105/127422025-05-29T17:20:50Zcom_20.500.12105_19604com_20.500.12105_2051col_20.500.12105_19605

00925njm 22002777a 4500 dc Lee, Joo Myung author Choi, Ki Hong author Doh, Joon Hyung author Nam, Chang Wook author Shin, Eun Seok author Hoshino, Masahiro author Murai, Tadashi author Yonetsu, Taishi author Mejía-Rentería, Hernán author Kakuta, Tsunekazu author Escaned, Javier author Koo, Bon-Kwon author 2020-10 Recent guideline recommends evaluation using of coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients with functionally insignificant stenosis. We evaluated clinical implications of CFR and IMR in patients with high fractional flow reserve (FFR) and deferred revascularization. A total of 867 patients (1,152 vessels) consigned to deferred revascularization who underwent comprehensive physiologic assessments were enrolled. Patients with high FFR (>0.80) were categorized by CFR (≤2) and IMR (≥23 U). Clinical outcome was assessed by patient-oriented composite outcome (POCO), a composite of any death, myocardial infarction (MI), and revascularization at 5 years. Patients with low CFR (≤2) showed significantly greater risk of POCO than those with high CFR (>2) in both high-FFR (p=0.024) and low-FFR (p=0.034) groups. In patients with high FFR, those with low CFR and high IMR (overt microvascular disease) displayed the greatest risk of POCO overall (p=0.015), surpassing those with high CFR and low IMR (HR, 2.873; 95% CI, 1.476-5.594; p=0.002) and showing significantly greater risk of cardiac death or MI (HR, 5.662; 95% CI, 1.984-16.154; p=0.001). Overt microvascular disease was independently associated with POCO in the high-FFR population (HR, 2.282; 95% CI, 1.176-4.429; p=0.015). Among patients with deferred revascularization, those with low CFR showed significantly greater risk of POCO than those with high CFR, regardless of FFR. In patients with high FFR, those with overt microvascular disease showed significantly greater risk of POCO and cardiac death or MI at 5-year, compared with the others. ClinicalTrials.gov Identifier: NCT03690713. Korean Circ J. 2020; 50(9):e101 10.4070/kcj.2020.0083 1738-5520 Korean circulation journal 32725991 http://hdl.handle.net/20.500.12105/12742 Myocardial ischemia Coronary artery disease Fractional flow reserve Coronary flow reserve Index of microcirculatory resistance Percutaneous coronary intervention Long-term Patient Prognostication by Coronary Flow Reserve and Index of Microcirculatory Resistance: International Registry of Comprehensive Physiologic Assessment