Skip to main content
SpringerLink
Log in

Seven-year clinical outcomes of patients with moderate coronary artery stenosis after deferral of revascularization based on gray-zone fractional flow reserve

  • Original Article
  • Published:
Cardiovascular Intervention and Therapeutics Aims and scope Submit manuscript

Abstract

The range (0.75–0.80) of fractional flow reserve (FFR) is known as the gray zone. Although the FFR of 0.80 was recently adopted as the cutoff value for coronary revascularization, the long-term clinical outcomes of patients with angiographically moderate coronary artery stenosis (FFR: 0.75–0.80) remain unknown. The objective of the present study was to investigate the clinical outcomes of patients with angiographically moderate coronary artery stenosis, whose FFR was 0.75–0.80. One hundred and twenty consecutive patients, for whom coronary revascularization was deferred based on FFR, were categorized to groups I and II, in which 55 and 65 patients had FFRs of 0.75–0.80 and 0.81–0.85, respectively. Adverse cardiac events included all-cause death, cardiac death, myocardial infarction, coronary revascularization for the FFR-measured and -unmeasured arteries, congestive heart failure, and admission for chest symptoms. Patients were followed up for 7 years after coronary angiography. Event-free survival rates of all adverse cardiac events were 73 % in group I and 63 % in group II (P = 0.35) and those of adverse cardiac events related to the FFR-measured artery were 94 and 85 % (P = 0.08). Throughout the follow-up period, the medication rate of statins was significantly lower in group II than in group I (P = 0.008). Seven-year clinical outcomes of patients with the gray-zone FFR were good. Furthermore, FFR-measured artery-related events in patients with the gray-zone FFR tended to occur less frequently than in patients with better FFR of 0.81–0.85. Optimal medical therapy is required for them, regardless of coronary stenosis severity and FFR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pijls NHJ, De Bruyne B, Peels K, van der Voort PH, Bonnier HJRM, Baartunek J, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996;334:1703–8.

    Article  CAS  PubMed  Google Scholar 

  2. Pijls NHJ. Fractional flow reserve to guide coronary revascularization. Circ J. 2013;77:561–9.

    Article  PubMed  Google Scholar 

  3. Pijls NHJ, Tanaka N, Fearon WF. Functional assessment of coronary stenoses: can we live without it? Eur Heart J. 2013;34:1335–44.

    Article  PubMed  Google Scholar 

  4. Tanaka N, Takazawa K, Shindo N, Kobayashi H, Teramoto T, Yamashita J, et al. Decrease of fractional flow reserve shortly after percutaneous coronary intervention. Circ J. 2006;70:1327–31.

    Article  PubMed  Google Scholar 

  5. Yamashita J, Tanaka N, Fujita H, Akasaka T, Takayama T, Oikawa Y, et al. Usefulness of functional assessment in the treatment of patients with moderate angiographic paclitaxel-eluting stent restenosis. Circ J. 2013;77:1180–5.

    Article  PubMed  Google Scholar 

  6. Pijls NHJ, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van’t Veer M, et al. Percutaneous coronary intervention of functionally non-significant stenosis: 5-year follow-up of the DEFER study. J Am Coll Cardiol. 2007;49:2105–11.

    Article  PubMed  Google Scholar 

  7. Park SJ, Kang SJ, Ahn JM, Shim EB, Kim YT, Yun SC, et al. Visual-functional mismatch between coronary angiography and fractional flow reserve. J Am Coll Cardiol Intv. 2012;5:1029–36.

    Article  Google Scholar 

  8. Pijls NHJ, Fearon WF, Tonino PAL, Siebert U, Ikeno F, Bornschein B, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease 2-year follow-up of the FAME (fractional flow reserve versus angiography for multivessel evaluation) study. J Am Coll Cardiol. 2010;56:177–84.

    Article  PubMed  Google Scholar 

  9. Nakamura M, Yamagishi M, Ueno T, Hara K, Ishiwata S, Itoh T, et al. Prevalence of visual–functional mismatch regarding coronary artery stenosis in the CVIT-DEFER registry. Cardiovasc Interv Ther. 2014;. doi:10.1007/s12928-014-0259-3.

    Google Scholar 

  10. Nakamura M, Yamagishi M, Ueno T, Hara K, Ishiwata S, Itoh T, et al. Modification of treatment strategy after FFR measurement: CVIT-DEFER registry. Cardiovasc Interv Ther. 2014;. doi:10.1007/s12928-014-0266-4.

    Google Scholar 

  11. Kern MJ, Lerman A, Bech JW, De Bruyne B, Eeckhout E, Fearon WF, et al. Physiological assessment of coronary artery disease in the cardiac catheterization laboratory. A scientific statement from the American heart association committee on diagnostic and interventional cardiac catheterization, Council on clinical cardiology. Circulation. 2006;114:1321–41.

    Article  PubMed  Google Scholar 

  12. Silber S, Albertsson P, Avilés FF, Camici PG, Colombo A, Hamm C, et al. Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the European society of cardiology. Eur Heart J. 2005;26:804–47.

    Article  PubMed  Google Scholar 

  13. Muller O, Mangiacapra F, Ntalianis A, Verhamme KMC, Trana C, Hamilos M, et al. Long-term follow-up after fractional flow reserve––guided treatment strategy in patients with an isolated proximal left anterior descending coronary artery stenosis. J Am Coll Cardiol Intv. 2011;4:1175–82.

    Article  Google Scholar 

  14. Courtis J, Rodés-Cabau J, Eric Larose E, Déry JP, Nguyen CM, Proulx G, et al. Comparison of medical treatment and coronary revascularization in patients with moderate coronary lesions and borderline fractional flow reserve measurements. Catheter Cardiovasc Interv. 2008;71:541–8.

    Article  PubMed  Google Scholar 

  15. Jeremias A, Whitbourn RJ, Filardo SD, Fitzgerald PJ, Cohen DJ, Tuzcu M, et al. Adequacy of intracoronary versus intravenous adenosine-induced maximal coronary hyperemia for fractional flow reserve measurements. Am Heart J. 2000;140:651–7.

    Article  CAS  PubMed  Google Scholar 

  16. Casella G, Leibig M, Schiele TM, Schrepf R, Seelig V, Stempfle HU, et al. Are high doses of intracoronary adenosine an alternative to standard intravenous adenosine for the assessment of fractional flow reserve? Am Heart J. 2004;148:590–5.

    Article  CAS  PubMed  Google Scholar 

  17. Lindstaedt M, Halilcavusogullari Y, Yazar A, Holland-Letz T, Bojara W, Mügge A, et al. Clinical outcome following conservative vs revascularization therapy in patients with stable coronary artery disease and borderline fractional flow reserve measurements. Clin Cardiol. 2010;33:77–83.

    Article  PubMed  Google Scholar 

  18. Moses JW, Stone GW, Nikolsky E, Mintz GS, Dangas G, Grube E, et al. Drug-eluting stents in the treatment of intermediate lesions Pooled analysis from four randomized trials. J Am Coll Cardiol. 2006;47:2164–71.

    Article  CAS  PubMed  Google Scholar 

  19. Lavi S, Rihal CS, Yang EH, Fassa AA, Elesber A, Lennon RJ, et al. The effect of drug eluting stents on cardiovascular events in patients with intermediate lesions and borderline fractional flow reserve. Catheter Cardiovasc Interv. 2007;70:525–31.

    Article  PubMed  Google Scholar 

  20. Lagerqvist B, James SK, Stenestrand U, Lindbäck J, Nilsson T, Wallentin L. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med. 2007;356:1009–19.

    Article  CAS  PubMed  Google Scholar 

  21. Sant’Anna FM, Silva EER, Batista LA, Ventura FM, Barrozo CAM, Pijls NHJ. Influence of routine assessment of fractional flow reserve on decision making during coronary interventions. Am J Cardiol. 2007;99:504–8.

    Article  PubMed  Google Scholar 

  22. Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, ennedy K. Appropriateness of percutaneous coronary intervention. JAMA. 2011;306:53–61.

    CAS  PubMed  Google Scholar 

  23. Nobuyoshi M, Tanaka M, Nosaka H, Kimura T, Yokoi H, Hamasaki N, et al. Progression of coronary atherosclerosis: is coronary spasm related to progression? J Am Coll Cardiol. 1991;18:904–10.

    Article  CAS  PubMed  Google Scholar 

  24. Giroud D, Li JM, Urban P, Meier B, Rutishauser W. Relation of the site of acute myocardial infarction to the most severe coronary arterial stenosis at prior angiography. Am J Cardiol. 1992;69:729–32.

    Article  CAS  PubMed  Google Scholar 

  25. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995;92:657–71.

    Article  CAS  PubMed  Google Scholar 

  26. Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Satoshi Sakima, MD, for his critical review of the manuscript.

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Jun Yamashita, Nobuhiro Tanaka, Kunihiro Sakoda, Naotaka Murata, Yohei Hokama, Kou Hoshino, Sayo Ikeda & Akira Yamashina

  2. Department of Cardiology, Niizashiki Central General Hospital, Saitama, Japan

    Naohisa Shindo

  3. Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan

    Masashi Ogawa

  4. Department of Cardiology, Toda Central General Hospital, Saitama, Japan

    Yo Kimura

Authors
  1. Jun Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nobuhiro Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naohisa Shindo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masashi Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yo Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kunihiro Sakoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Naotaka Murata
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yohei Hokama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kou Hoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sayo Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Akira Yamashina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jun Yamashita.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamashita, J., Tanaka, N., Shindo, N. et al. Seven-year clinical outcomes of patients with moderate coronary artery stenosis after deferral of revascularization based on gray-zone fractional flow reserve. Cardiovasc Interv and Ther 30, 209–215 (2015). https://doi.org/10.1007/s12928-014-0302-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12928-014-0302-4

Keywords

Search

Navigation