Clinical Efficacy of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Coronary Heart Disease Patients with SYNTAX Score ≥33 and Euro Score ≥6: A Single-Center Retrospective Analysis

Authors

  • Zhiyong Wu Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, 330000 Nanchang, Jiangxi, China
  • Xuanlan Chen Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, 330000 Nanchang, Jiangxi, China
  • Yizhong Zhou Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, 330000 Nanchang, Jiangxi, China
  • Nanping Gong Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, 330000 Nanchang, Jiangxi, China
  • Zhitang Chang Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, 330000 Nanchang, Jiangxi, China

DOI:

https://doi.org/10.59958/hsf.6839

Keywords:

fractional flow reserve, percutaneous coronary intervention, SYNTAX score, Euro Score, coronary artery bypass graft

Abstract

Objective: To observe clinical efficacy of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in coronary heart disease patients with SYNTAX scores (SS) ≥33 and Euro Scores (ES) ≥6 who are unsuitable for or have declined coronary artery bypass graft (CABG). Methods: A total of 117 patients with SS ≥33 and Euro Score (ES) ≥6 who were unsuitable for and/or who had declined CABG between Jan 2021 and June 2022 were enrolled in this retrospective analysis. All patients accepted optimal medical therapy and some accepted an FFR-guided PCI procedure. Patients who only underwent optimal medical therapy were divided into the optimal medical therapy group (OMT group) and patients who simultaneously underwent FFR-guided PCI procedure were divided into the PCI group in this retrospective analysis. All patients accepted follow-up for at least 12 months after discharge. Results: SS and ES in the two groups were not statistically different (p > 0.05). Patients with chronic total occlusion accounted for a greater proportion in the PCI subgroup (31.3%, 5/16) than in other subgroups. Eighteen (18.6%, 18/97) cases in the PCI group developed major adverse cardiac and cerebrovascular events (MACCEs). There were 12 (60%, 12/20) cases of MACCEs in the OMT group, which was statistically different from the PCI group (p < 0.05). Conclusions: Based on optimal medical therapy, FFR-guided PCI can still have clinical benefit to coronary artery disease patients with SS ≥33 who were not suitable for CABG.

References

Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2005; 1: 219–227.

Haberal I, Balli M, Tekin EE, Uysal A, Ozsoy SD, Yesiltas MA, et al. SYNTAX and Coronary Artery Calcium Score Predict Atherosclerotic Plaque Formation in the Ascending Aorta. The Heart Surgery Forum. 2021; 2021: E996–E1004.

Peng C, Wu H, Kim S, Dai X, Jiang X. Recent Advances in Transducers for Intravascular Ultrasound (IVUS) Imaging. Sensors (Basel, Switzerland). 2021; 21: 3540.

Reiber JH, Tu S, Tuinenburg JC, Koning G, Janssen JP, Dijkstra J. QCA, IVUS and OCT in interventional cardiology in 2011. Cardiovascular diagnosis and therapy. 2011; 1: 57–70.

Dykun I, Babinets O, Hendricks S, Balcer B, Puri R, Al-Rashid F, et al. Utilization of IVUS improves all-cause mortality in patients undergoing invasive coronary angiography. Atherosclerosis Plus. 2021; 43: 10–17.

Lee JM, Shin E, Nam C, Doh J, Hwang D, Park J, et al. Clinical Outcomes According to Fractional Flow Reserve or Instantaneous Wave-Free Ratio in Deferred Lesions. JACC: Cardiovascular Interventions. 2017; 10: 2502–2510.

Reuter H, Baldus S. FFR-gesteuerte Revaskularisation – wann indiziert, wann überflüssig? DMW - Deutsche Medizinische Wochenschrift. 2017; 142: 1595–1603.

van Nunen LX, Zimmermann FM, Tonino PAL, Barbato E, Baumbach A, Engstrøm T, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet. 2015; 386: 1853–1860.

Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es G, et al. Clinical End Points in Coronary Stent Trials. Circulation. 2007; 115: 2344–2351.

Lemesle G, Delhaye C, Bonello L, de Labriolle A, Waksman R, Pichard A. Stent thrombosis in 2008: Definition, predictors, prognosis and treatment. Archives of Cardiovascular Diseases. 2008; 101: 769–777.

McGillion M, Arthur HM, Cook A, Carroll SL, Victor JC, L'Allier PL, et al. Management of Patients with Refractory Angina: Canadian Cardiovascular Society/Canadian Pain Society Joint Guidelines. Canadian Journal of Cardiology. 2012; 28: S20–S41.

Serruys PW, Morice M, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. New England Journal of Medicine. 2009; 360: 961–972.

Toumpoulis IK, Anagnostopoulos CE, DeRose JJ, Swistel DG. European system for cardiac operative risk evaluation predicts long-term survival in patients with coronary artery bypass grafting. European Journal of Cardio-Thoracic Surgery. 2004; 25: 51–58.

Head SJ, Davierwala PM, Serruys PW, Redwood SR, Colombo A, Mack MJ, et al. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. European Heart Journal. 2014; 35: 2821–2830.

Takahashi K, Serruys PW, Gao C, Ono M, Wang R, Thuijs DJFM, et al. Ten-Year all-Cause Death According to Completeness of Revascularization in Patients with Three-Vessel Disease or Left Main Coronary Artery Disease: Insights from the SYNTAX Extended Survival Study. Circulation. 2021; 144: 96–109.

Alam M, Huang HD, Shahzad SA, Kar B, Virani SS, Rogers PA, et al. Percutaneous Coronary Intervention vs. Coronary Artery Bypass Graft Surgery for Unprotected Left Main Coronary Artery Disease in the Drug-Eluting Stents Era. Circulation Journal. 2013; 77: 372–382.

Mohr FW, Morice M, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013; 381: 629–638.

Pijls NH, Fearon WF, Tonino PA, 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. Journal of the American College of Cardiology. 2010; 56: 177–184.

Tonino PA, Fearon WF, De Bruyne B, Oldroyd KG, Leesar MA, Ver Lee PN, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. Journal of the American College of Cardiology. 2010; 55: 2816–2821.

Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. Journal of the American College of Cardiology. 2017; 69: 2212–2241.

White CW, Wright CB, Doty DB, Hiratza LF, Eastham CL, Harrison DG, et al. Does Visual Interpretation of the Coronary Arteriogram Predict the Physiologic Importance of a Coronary Stenosis? New England Journal of Medicine. 1984; 310: 819–824.

Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). European heart journal. 2014 ;35: 2541–2619.

Adjedj J, Stoyanov N, Muller O. Comparison of coronary angiography and intracoronary imaging with fractional flow reserve for coronary artery disease evaluation: An anatomical-functional mismatch. Anatolian journal of cardiology. 2018; 20: 182–189.

Zhang J, Gao X, Kan J, Ge Z, Han L, Lu S, et al. Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation. Journal of the American College of Cardiology. 2018; 72: 3126–3137.

Budrys P, Peace A, Baranauskas A, Davidavicius G. Intravascular Ultrasound vs. Fractional Flow Reserve for Percutaneous Coronary Intervention Optimization in Long Coronary Artery Lesions. Diagnostics (Basel, Switzerland). 2023; 13: 2921.

Kong MG, Han J, Kang J, Zheng C, Yang H, Park KW, et al. Clinical outcomes of long stenting in the drug-eluting stent era: patient-level pooled analysis from the GRAND-DES registry. EuroIntervention. 2021; 16: 1318–1325.

Konstantinidis NV, Werner GS, Deftereos S, Di Mario C, Galassi AR, Buettner JH, et al. Temporal Trends in Chronic Total Occlusion Interventions in Europe. Circulation: Cardiovascular Interventions. 2018; 11: e006229.

Xenogiannis I, Choi JW, Alaswad K, Khatri JJ, Doing AH, Dattilo P, et al. Outcomes of subintimal plaque modification in chronic total occlusion percutaneous coronary intervention. Catheterization and Cardiovascular Interventions. 2020; 96: 1029–1035.

Tanaka H, Tsuchikane E, Muramatsu T, Kishi K, Muto M, Oikawa Y, et al. A Novel Algorithm for Treating Chronic Total Coronary Artery Occlusion. Journal of the American College of Cardiology. 2019; 74: 2392–2404.

Katoh H, Yamane M, Muramatsu T, Okamura A, Kashima Y, Matsuno S, et al. Safety of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients with Multi-Vessel Disease: Sub-Analysis of the Japanese Retrograde Summit Registry. Cardiovascular Revascularization Medicine. 2021; 25: 36–42.

Maeremans J, Walsh S, Knaapen P, Spratt JC, Avran A, Hanratty CG, et al. The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe: The RECHARGE Registry. Journal of the American College of Cardiology. 2016; 68: 1958–1970.

Published

2023-12-27

How to Cite

Wu, Z., Chen, X., Zhou, Y., Gong, N., & Chang, Z. (2023). Clinical Efficacy of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Coronary Heart Disease Patients with SYNTAX Score ≥33 and Euro Score ≥6: A Single-Center Retrospective Analysis. The Heart Surgery Forum, 26(6), E817-E825. https://doi.org/10.59958/hsf.6839

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