Background:Coronary pressure indices such as fractional flow reserve are the standard for guiding elective revascularization. However, considering additional coronary flow parameters could further individualize and optimize the decision on revascularization. We aimed to investigate the potentially differential prognostic associations of elective percutaneous coronary intervention (PCI) according to coronary flow properties represented by coronary flow reserve (CFR), coronary flow capacity (CFC), and baseline CFC (bCFC).Methods:From the ILIAS Registry (Inclusive Invasive Physiological Assessment in Angina Syndromes) composed of 16 hospitals globally from 7 countries, patients with obstructive coronary artery disease who underwent invasive coronary physiological assessment were included (N=2370 vessels). We assessed effect measure modifications of the association of PCI and 5-year target vessel failure according to CFR, CFC, and bCFC either assessed by Doppler-technique or thermodilution-method.Results:The mean age of the population was 63.3 years, and there were 1322 (73.6%) males. Median fractional flow reserve was 0.85, and PCI was performed in 600 (25.3%) vessels. Reduced CFR, CFC, and abnormal bCFC were defined in 988 (41.7%), 542 (22.9%), and 600 (25.3%) vessels, respectively. Significant effect measure modifications were observed by CFC either in odds ratio (P=0.0018), additive (P=0.029), and hazard ratio scale (P=0.0002). The absolute risk of 5-year target-vessel failure was higher if treated by PCI in vessels with normal CFC by 1.8 (−1.7 to 5.3) percent, while that was lower by −5.9 (−12 to −0.1) percent in those with reduced CFC. CFR and bCFC were not significant effect modifiers in any scales. Similar associations were observed in per-patient analyses, whereas the findings were less robust.Conclusions:We observed qualitative effect measure modification of PCI and 5-year clinical outcomes according to CFC status in additive scale. CFR and bCFC were not robust effect modifiers. Therefore, CFC could be potentially used to optimize the patient selection for elective PCI treatment combined with fractional flow reserve.

中文翻译：

---

根据冠状动脉血流特征，冠状动脉血运重建对长期临床结果的不同影响：国际 ILIAS 注册分析

背景：血流储备分数等冠状动脉压力指标是指导择期血运重建的标准。然而，考虑额外的冠状动脉血流参数可以进一步个性化和优化血运重建决策。我们旨在根据冠状动脉血流储备 (CFR)、冠状动脉血流容量 (CFC) 和基线 CFC (bCFC) 所代表的冠状动脉血流特性，研究选择性经皮冠状动脉介入治疗 (PCI) 的潜在差异预后关联。方法：来自 ILIAS登记处（心绞痛综合征的包容性侵入性生理评估）由来自全球 7 个国家的 16 家医院组成，包括接受侵入性冠状动脉生理评估的阻塞性冠状动脉疾病患者（N=2370 支血管）。我们根据多普勒技术或热稀释法评估的 CFR、CFC 和 bCFC 评估 PCI 和 5 年目标血管衰竭关联的效果测量修改。结果：人群的平均年龄为 63.3 岁，并且有为 1322 (73.6%) 名男性。中位血流储备分数为 0.85，在 600 支 (25.3%) 血管中进行了 PCI。分别在 988 例 (41.7%)、542 例 (22.9%) 和 600 例 (25.3%) 血管中定义了 CFR、CFC 和异常 bCFC。CFC 观察到显着的效果测量修改，无论是优势比（600 支 (25.3%) 血管进行了 PCI。分别在 988 例 (41.7%)、542 例 (22.9%) 和 600 例 (25.3%) 血管中定义了 CFR、CFC 和异常 bCFC。CFC 观察到显着的效果测量修改，无论是优势比（600 支 (25.3%) 血管进行了 PCI。分别在 988 例 (41.7%)、542 例 (22.9%) 和 600 例 (25.3%) 血管中定义了 CFR、CFC 和异常 bCFC。CFC 观察到显着的效果测量修改，无论是优势比（P = 0.0018）、加性（P = 0.029）和风险比量表（P = 0.0002）。如果在 CFC 正常的血管中接受 PCI 治疗，5 年目标血管衰竭的绝对风险会增加 1.8%（-1.7 至 5.3）%，而在 CFC 正常的血管中则降低 -5.9%（-12 至 -0.1%）。减少氟氯化碳。CFR 和 bCFC 在任何尺度上都不是显着的效果修饰符。在每位患者的分析中观察到了类似的关联，但研究结果不太可靠。结论：我们观察到根据加法量表中的 CFC 状态对 PCI 和 5 年临床结果的定性效果测量修改。CFR 和 bCFC 不是稳健的效果调节剂。因此，CFC 可用于优化选择性 PCI 治疗与部分流量储备相结合的患者选择。