Faria, DanielMejía Rentería, Hernán DavidLee, Joo MyungLee, Seung HunTravieso, AlejandroJung, Ji‐HyunDoh, Joon HyungNam, Chang WookShin, Eun SeokHoshino, MasahiroSugiyama, TomoyoKanaji, YoshihisaGonzalo, NievesKakuta, TsunekazuKoo, Bon KwonEscaned, Javier2023-06-222023-06-222022-10-231522-194610.1002/ccd.30445https://hdl.handle.net/20.500.14352/72616CRUE-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.engAtribución-NoComercial 3.0 Españajournal articlehttps://doi.org/10.1002/ccd.30445https://onlinelibrary.wiley.com/doi/full/10.1002/ccd.30445open accessCardiología3205.01 Cardiología