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Safety of coronary revascularization deferral based on fractional flow reserve and instantaneous wave-free ratio in patients with chronic kidney disease

Alejandro Travieso, Alex Fernando Castro-Mejia, Adrian Jeronimo-Baza, Maria Jose Perez-Vizcayno, Hernan Mejia-Renteria, Fernando Macaya, Gabriela Tirado-Conte, Luis Nombela, Pilar Jimenez-Quevedo, Pablo Salinas, Ivan J. Nunez-Gil, Antonio Fernandez-Ortiz, Javier Escaned, Nieves Gonzalo
DOI: 10.5603/CJ.a2021.0035
·
Pubmed: 33843040

open access

Ahead of print
Original articles
Published online: 2021-03-10

Abstract

Background: The safety of revascularization deferral according to pressure wire examination in patients with chronic kidney disease (CKD) has not been fully established.

Methods: From a retrospective cohort of 439 patients in whom revascularization was deferred after physiological assessment, we examined the incidence of patient-oriented composite endpoint (POCE: all-cause death, myocardial infarction [MI] and unplanned revascularization) in patients with CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2) and without it.

Results: At 4 years of follow-up, the primary endpoint was met by 25.0% of patients with CKD and by 14.4% of patients without CKD (hazard ratio [HR] 1.56, 95% confidence interval [CI] 0.96–2.53, p = 0.071). The incidence of POCE was even higher in patients with an eGFR < 30 mL/min/1.73 m2: 43.8% (HR 3.10, 95% CI 1.08–8.92, p = 0.036). However, no differences were observed in the incidence of MI (4.2% vs. 4.4% in non-CKD), target vessel revascularization (5.8% vs. 5.9%), and target vessel MI (0.8% vs. 4.6%).

Conclusions: Patients with CKD in whom pressure-wire evaluation led to deferral of coronary revascularization develop more POCE in the long term, compared to patients with normal renal function. However, the increase in POCE in patients with CKD was seldom related to deferred vessels, thus suggesting an epiphenomenon of an intrinsically higher cardiovascular risk of CKD patients.

Abstract

Background: The safety of revascularization deferral according to pressure wire examination in patients with chronic kidney disease (CKD) has not been fully established.

Methods: From a retrospective cohort of 439 patients in whom revascularization was deferred after physiological assessment, we examined the incidence of patient-oriented composite endpoint (POCE: all-cause death, myocardial infarction [MI] and unplanned revascularization) in patients with CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2) and without it.

Results: At 4 years of follow-up, the primary endpoint was met by 25.0% of patients with CKD and by 14.4% of patients without CKD (hazard ratio [HR] 1.56, 95% confidence interval [CI] 0.96–2.53, p = 0.071). The incidence of POCE was even higher in patients with an eGFR < 30 mL/min/1.73 m2: 43.8% (HR 3.10, 95% CI 1.08–8.92, p = 0.036). However, no differences were observed in the incidence of MI (4.2% vs. 4.4% in non-CKD), target vessel revascularization (5.8% vs. 5.9%), and target vessel MI (0.8% vs. 4.6%).

Conclusions: Patients with CKD in whom pressure-wire evaluation led to deferral of coronary revascularization develop more POCE in the long term, compared to patients with normal renal function. However, the increase in POCE in patients with CKD was seldom related to deferred vessels, thus suggesting an epiphenomenon of an intrinsically higher cardiovascular risk of CKD patients.

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Keywords

pressure wire, fractional flow reserve, instantaneous wave-free ratio, chronic kidney disease

About this article
Title

Safety of coronary revascularization deferral based on fractional flow reserve and instantaneous wave-free ratio in patients with chronic kidney disease

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-03-10

DOI

10.5603/CJ.a2021.0035

Pubmed

33843040

Keywords

pressure wire
fractional flow reserve
instantaneous wave-free ratio
chronic kidney disease

Authors

Alejandro Travieso
Alex Fernando Castro-Mejia
Adrian Jeronimo-Baza
Maria Jose Perez-Vizcayno
Hernan Mejia-Renteria
Fernando Macaya
Gabriela Tirado-Conte
Luis Nombela
Pilar Jimenez-Quevedo
Pablo Salinas
Ivan J. Nunez-Gil
Antonio Fernandez-Ortiz
Javier Escaned
Nieves Gonzalo

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