Prognostic Impact of Residual Anatomic Disease Burden After Functionally Complete Revascularization
Joo Myung Lee, Doyeon Hwang, Ki Hong Choi, Hyun‐Jong Lee, Young Bin Song, Yun‐Kyeong Cho, Chang‐Wook Nam, Joo‐Yong Hahn, Eun‐Seok Shin, Joon‐Hyung Doh, Masahiro Hoshino, Rikuta Hamaya, Yoshihisa Kanaji, Tadashi Murai, Junjie Zhang, Fei Ye, Xiaobo Li, Zhen Ge, Shao‐Liang Chen, Tsunekazu Kakuta, Bon‐Kwon Koo
Abstract
Background: Prognostic impact of residual anatomic disease burden after functionally complete percutaneous coronary intervention (PCI), defined by post-PCI fractional flow reserve (FFR) >0.80 would be a clinically relevant question. The current study evaluated clinical outcomes at 2 years according to residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (RSS) in patients who underwent functionally complete revascularization. Methods: A total of 1910 patients (2095 revascularized vessels) with post-PCI FFR >0.80 were selected from the International Post-PCI FFR Registry. RSS was defined as the SYNTAX score recalculated after PCI, SYNTAX revascularization index was calculated as 100×(1−RSS/pre-PCI SYNTAX score), and post-PCI FFR was measured after completion of PCI. The primary outcome was target vessel failure (TVF; a composite of cardiac death, target vessel–related myocardial infarction, and clinically driven target vessel revascularization) at 2 years, and risk of TVF was compared according to tertile classification of RSS (0, 1–5, and >5) and post-PCI FFR (≥0.94, 0.87–0.93, and ≤0.86). Results: After PCI, SYNTAX score was changed from 10.0 (Q1–Q3, 7.0–16.0) to 0.0 (Q1–Q3, 0.0–5.0) and FFR changed from 0.70±0.12 to 0.90±0.05. TVF at 2 years occurred in 4.9%, and patients with TVF showed higher pre-PCI SYNTAX score and lower post-PCI FFR than those without. However, there were no significant differences in SYNTAX revascularization index and RSS. The risk of TVF was not different according to tertile of RSS (log-rank P =0.851). Conversely, risk of TVF was different according to tertile of post-PCI FFR (log-rank P =0.009). Multivariable model showed the risk of TVF was significantly associated with post-PCI FFR (hazard ratio, 1.091 [95% CI, 1.032–1.153]; P =0.002) but not with RSS (hazard ratio, 0.969 [95% CI, 0.898–1.045]; P =0.417). Conclusions: Among patients who underwent functionally complete revascularization, residual anatomic disease burden assessed by RSS was not related with occurrence of TVF at 2 years. These results support the importance of functionally complete revascularization rather than angiographic complete revascularization. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04012281.