2026-06-29T07:22:28Zhttps://docta.ucm.es/rest/oai/request

oai:docta.ucm.es:20.500.14352/726162024-10-09T16:39:19Zcom_20.500.14352_14col_20.500.14352_15

Age‐related changes in the coronary microcirculation influencing the diagnostic performance of invasive pressure‐based indices and long‐term patient prognosis Faria, Daniel Mejía Rentería, Hernán David Lee, Joo Myung Lee, Seung Hun Travieso, Alejandro Jung, Ji‐Hyun Doh, Joon Hyung Nam, Chang Wook Shin, Eun Seok Hoshino, Masahiro Sugiyama, Tomoyo Kanaji, Yoshihisa Gonzalo, Nieves Kakuta, Tsunekazu Koo, Bon Kwon Escaned Barbosa, Javier Cardiología 3205.01 Cardiología CRUE-CSIC (Acuerdos Transformativos 2022) Objectives Investigate age-related changes in coronary microvascular function, its effect on hyperemic and non-hyperemic indices of stenosis relevance, and its prognostic implications. Background Evidence 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. Methods This 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. Results Age 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). Conlusions Aging 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. Depto. de Medicina Fac. de Medicina TRUE pub 2023-06-22T12:28:35Z 2023-06-22T12:28:35Z 2022-10-23 journal article https://hdl.handle.net/20.500.14352/72616 1522-1946 10.1002/ccd.30445 eng Atribución-NoComercial 3.0 España https://creativecommons.org/licenses/by-nc/3.0/es/ open access application/pdf Wiley