RT Journal Article
T1 Age‐related changes in the coronary microcirculation influencing the diagnostic performance of invasive pressure‐based indices and long‐term patient prognosis
A1 Faria, Daniel
A1 Mejía Rentería, Hernán David
A1 Lee, Joo Myung
A1 Lee, Seung Hun
A1 Travieso, Alejandro
A1 Jung, Ji‐Hyun
A1 Doh, Joon Hyung
A1 Nam, Chang Wook
A1 Shin, Eun Seok
A1 Hoshino, Masahiro
A1 Sugiyama, Tomoyo
A1 Kanaji, Yoshihisa
A1 Gonzalo, Nieves
A1 Kakuta, Tsunekazu
A1 Koo, Bon Kwon
A1 Escaned, Javier
AB 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.
PB Wiley
SN 1522-1946
YR 2022
FD 2022-10-23
LK https://hdl.handle.net/20.500.14352/72616
UL https://hdl.handle.net/20.500.14352/72616
LA eng
NO CRUE-CSIC (Acuerdos Transformativos 2022)
DS Docta Complutense
RD 4 may 2024