Abnormal physiological findings after FFR-based revascularisation deferral are associated with worse prognosis in women

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

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The prognostic value of abnormal resting Pd/Pa and coronary flow reserve (CFR) after fractional flow reserve (FFR)-guided revascularisation deferral according to sex remains unknown. From the ILIAS Registry composed of 20 hospitals globally from 7 countries, patients with deferred lesions following FFR assessment (FFR > 0.8) were included. (NCT 04485234) The primary clinical endpoint was target vessel failure (TVF) at 2-years follow-up. We included 1392 patients with 1759 vessels (n = 564 women, 31.9%). Although resting Pd/Pa was similar between the sexes (p = 0.116), women had lower CFR than men (2.5 [2.0–3.2] vs. 2.7 [2.1–3.5]; p = 0.004). During a 2-year follow-up period, TVF events occurred in 56 vessels (3.2%). The risk of 2-year TVF was significantly higher in women with low versus high resting Pd/Pa (HR: 9.79; p < 0.001), whereas this trend was not seen in men. (Sex: P-value for interaction = 0.022) Furthermore, resting Pd/Pa provided an incremental prognostic value for 2-year TVF over CFR assessment only in women. After FFR-based revascularisation deferral, low resting Pd/Pa is associated with higher risk of TVF in women, but not in men. The predictive value of Pd/Pa increases when stratified according to CFR values, with significantly high TVF rates in women in whom both indices are concordantly abnormal. Clinical Trial Registration: Inclusive Invasive Physiological Assessment in Angina Syndromes Registry (ILIAS Registry), NCT04485234.

Original languageEnglish
Article number1027
JournalScientific reports
Issue number1
Publication statusPublished - 1 Dec 2023

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