Abstract
Fractional flow reserve (FFR)-guided percutaneous coronary intervention has shown favorable long-term clinical outcomes. However, limited data exist evaluating the FFR assessment among the chronic kidney disease (CKD) population. The aim of this study was to evaluate the long-term clinical outcomes of FFR-guided coronary revascularization in patients with CKD. A total of 242 CKD patients who underwent FFR assessment were retrospectively analyzed. Patients were divided into two groups: revascularization (FFR ≤ 0.80) and non-revascularization (FFR > 0.80). The primary endpoint was the composite of cardiac death, non-fatal myocardial infarction, and target vessel failure (TVF). The key secondary endpoint was TVF. The Cox regression model was used for risk evaluation. With 91% of the ischemic vessels revascularized, the revascularization group had higher risks for both the primary endpoint (adjusted hazard ratio [aHR]: 2.06; 95% confidence interval [CI], 1.07–3.97; p = 0.030) and key secondary endpoint (aHR: 2.19, 95% CI: 1.10–4.37; p = 0.026), during a median follow-up of 2.9 years. This result was consistent among different CKD severities. In patients with CKD, functional ischemia in coronary artery stenosis was associated with poor clinical outcomes despite coronary revascularization.
Highlights
The global burden of chronic kidney disease (CKD) has increased and is accompanied by an important risk factor for cardiovascular disease [1]
The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches–Chronic Kidney Disease (ISCHEMIA-CKD) trial showed no benefit of an initial invasive strategy in stable coronary artery disease (CAD) with advanced CKD and moderate to severe ischemia compared with initial medical therapy [5]
This study aimed to evaluate the efficacy of Fractional flow reserve (FFR)-guided coronary artery revascularization in patients with CKD, including those with end-stage kidney disease
Summary
The global burden of chronic kidney disease (CKD) has increased and is accompanied by an important risk factor for cardiovascular disease [1]. Patients with CKD have a higher prevalence of cardiac mortality and cardiovascular disease [3,4]. Screening for coronary artery disease (CAD) and optimizing coronary revascularization are important issues in the CKD population. The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches–Chronic Kidney Disease (ISCHEMIA-CKD) trial showed no benefit of an initial invasive strategy in stable CAD with advanced CKD and moderate to severe ischemia compared with initial medical therapy [5]. The screening tool in this trial was noninvasive and involved mainly nuclear imaging studies, which provided suboptimal predictive value for obstructive CAD in CKD [6]
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