Abstract:
BACKGROUND:Deferring percutaneous coronary intervention in nonischemic lesions by fractional flow reserve (FFR) is associated with excellent long-term prognosis in patients with stable ischemic heart disease (SIHD). Although FFR is increasingly used for clinical decision making in acute coronary syndrome (ACS) patients with intermediate lesions, its effect on long-term prognosis has not been well established. OBJECTIVES:This study investigated the clinical and prognostic utility of FFR in ACS patients with percutaneous coronary intervention deferred on the basis of nonischemic FFR. METHODS:We studied 206 consecutive ACS patients with 262 intermediate lesions and 370 patients with SIHD (528 lesions) in whom revascularization was deferred on the basis of a nonischemic FFR (>0.75). The primary outcome measure was a composite of myocardial infarction and target vessel failure (major adverse cardiovascular events [MACE]). RESULTS:In the entire cohort, the long-term (3.4 ± 1.6 years) MACE rate was higher in the ACS group than in the SIHD group (23% vs. 11%, p < 0.0001). After propensity score matching (200 patients/group), MACE remained significantly higher (ACS 25% vs. SIHD 12%; p < 0.0001). On Cox proportional hazards analysis for MACE, ACS had a hazard ratio of 2.8 (95% confidence interval: 1.9 to 4.0; p < 0.0001). In both the matched and unmatched cohorts, across all FFR categories, ACS patients had a significantly higher annualized myocardial infarction/target vessel revascularization rate compared with SIHD (p < 0.05). Receiver-operating characteristic analysis identified FFR cutoffs (best predictive accuracy for MACE) of <0.84 for ACS (MACE 21% vs. 36%; p = 0.007) and <0.81 for SIHD (MACE 17% vs. 9%; p = 0.01). CONCLUSIONS:Deferring percutaneous coronary intervention on the basis of nonischemic FFR in patients with an initial presentation of ACS is associated with significantly worse outcomes than SIHD. Caution is warranted in using FFR values derived from patients with SIHD for clinical decision making in ACS patients.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Hakeem A,Edupuganti MM,Almomani A,Pothineni NV,Payne J,Abualsuod AM,Bhatti S,Ahmed Z,Uretsky BFdoi
10.1016/j.jacc.2016.06.035subject
Has Abstractpub_date
2016-09-13 00:00:00pages
1181-1191issue
11eissn
0735-1097issn
1558-3597pii
S0735-1097(16)34441-2journal_volume
68pub_type
杂志文章abstract:OBJECTIVES:This study sought to characterize the spontaneous onset of atrial flutter in patients. BACKGROUND:Temporary epicardial electrodes are routinely placed on the atria of patients at the time of open heart surgery and brought out through the anterior chest wall for potential diagnostic and therapeutic use in th...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(96)00223-9
更新日期:1996-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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abstract:OBJECTIVES:This study was undertaken to assess prospectively the prognostic power of early ST segment elevation resolution in a large cohort of patients with myocardial infarction and to test the value of differences in ST segment resolution as a surrogate end point. BACKGROUND:Previous studies revealed that the use o...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/0735-1097(95)00372-x
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVES:This study was designed to evaluate the relationship among blood pressure (BP) levels, risk of sudden cardiac death (SCD), and benefit of the implantable cardioverter-defibrillator (ICD) in patients with ischemic left ventricular (LV) dysfunction. BACKGROUND:Low BP has been shown to be associated with incre...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/j.jacc.2006.11.042
更新日期:2007-04-03 00:00:00
abstract:OBJECTIVES:We studied the hypothesis that in the absence of vascular pathology, coronary artery vasospasm occurs as a result of local regions of vascular muscle hyperreactivity. We aimed to explore the basis for a functional etiology of those vasospasms not explained on a structural basis. BACKGROUND:Ovariectomized rh...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(96)00524-4
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVES:This study sought to characterize the echocardiographic features of straddling mitral valve (SMV) and to determine its surgical implications and midterm outcome in a large clinical cohort. BACKGROUND:Despite a relatively large body of literature on the postmortem anatomy of SMV, there is a paucity of inform...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01441-3
更新日期:2001-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/S0735-1097(96)00381-6
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVES:The aim of our study was to evaluate arterial embolism (AE) occurrence rates and predictors in patients suffering from bradycardia and wearing a pacemaker with antitachycardia pacing therapies. BACKGROUND:Atrial fibrillation (AF) is associated with a high incidence of AE. METHODS:A total of 725 patients (3...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
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更新日期:2005-11-15 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(98)00095-3
更新日期:1998-05-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(10)80261-x
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2006.03.046
更新日期:2006-08-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80206-1
更新日期:1987-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(89)90021-1
更新日期:1989-12-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(98)00317-9
更新日期:1998-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2013.05.029
更新日期:2013-09-10 00:00:00
abstract:OBJECTIVES:We sought to demonstrate the electrophysiologic (EP) mechanism of the ST-T change in Brugada syndrome. BACKGROUND:Brugada syndrome is characterized by various electrocardiographic manifestations (e.g., right bundle branch block, ST-segment elevation, and terminal T-wave inversion in the right precordial lea...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(02)01964-2
更新日期:2002-07-17 00:00:00
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doi:10.1016/s0735-1097(02)01890-9
更新日期:2002-06-19 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2003-11-05 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2012-05-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
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更新日期:2009-06-23 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:2012-01-10 00:00:00
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更新日期:2019-01-22 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:1986-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80105-5
更新日期:1987-01-01 00:00:00
abstract:BACKGROUND:Familial restrictive cardiomyopathy (FRCM) has a poor prognosis due to diastolic dysfunction and restrictive physiology (RP). Myocardial stiffness, with or without fibrosis, underlie RP, but the mechanism(s) of restrictive remodeling is unclear. Myopalladin (MYPN) is a messenger molecule that links structura...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:2014-12-30 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2010-04-20 00:00:00