%0 Journal Article
%A Faria, Daniel
%A Mejía Rentería, Hernán David
%A Lee, Joo Myung
%A Lee, Seung Hun
%A Travieso, Alejandro
%A Jung, Ji‐Hyun
%A Doh, Joon Hyung
%A Nam, Chang Wook
%A Shin, Eun Seok
%A Hoshino, Masahiro
%A Sugiyama, Tomoyo
%A Kanaji, Yoshihisa
%A Gonzalo, Nieves
%A Kakuta, Tsunekazu
%A Koo, Bon Kwon
%A Escaned Barbosa, Javier
%T Age‐related changes in the coronary microcirculation influencing the diagnostic performance of invasive pressure‐based indices and long‐term patient prognosis
%D 2022
%@ 1522-1946
%U https://hdl.handle.net/20.500.14352/72616
%X ObjectivesInvestigate age-related changes in coronary microvascular function, its effect on hyperemic and non-hyperemic indices of stenosis relevance, and its prognostic implications.BackgroundEvidence assessing the effect of age on fractional flow reserve (FFR), resting mean distal intracoronary pressure/mean aortic pressure (Pd/Pa), and microcirculatory function remains scarce.MethodsThis is a post hoc study of a large prospective international registry (NCT03690713) including 1134 patients (1326 vessels) with coronary stenoses interrogated with pressure and flow guidewires. Age-dependent correlations with functional indices were analyzed. Prevalences of FFR, resting Pd/Pa, and coronary flow reserve (CFR) classification agreement were assessed. At 5 years follow-up, the relation between resting Pd/Pa, CFR, and their age-dependent implications on FFR-guided percutaneous coronary intervention (PCI) deferral (deferred if FFR > 0.80) were investigated using vessel-oriented composite outcomes (VOCO) composed of death, myocardial infarction, and repeated revascularization.ResultsAge correlated positively with FFR (r = 0.08, 95% confidence interval [CI]: 0.03 to 0.13, p =  0.005), but not with resting Pd/Pa (r = −0.03, 95% CI:−0.09 to 0.02, p = 0.242). CFR correlated negatively with age (r = −0.15, 95% CI: −0.21 to −0.10, p < 0.001) due to a significant decrease in maximal hyperemic flow in older patients. Patients over 60 years of age with FFR-guided deferred-PCI abnormal resting Pd/Pa or abnormal CFR had increased risk of VOCO (hazard ratio [HR]: 2.10, 95% CI: 1.15 to 4.36, p = 0.048; HR: 2.46, 95% CI:1.23 to 4.96, p = 0.011; respectively).ConlusionsAging is associated with decrease in microcirculatory vasodilation, as assessed with adenosine-based methods like CFR. In patients older than 60 years in whom PCI is deferred according to FFR > 0.80, CFR and resting Pd/Pa have an incremental value in predicting future vessel-oriented patient outcomes.
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