Wenming He, Wenbin Tang, Jinlong Zhang, Xianpeng Wu, Haoxuan Lu, Yanqing Xie, Xiaomin Chen, Yong Sun, Changling Li, Lingjun Zhu, Feng Gao, Liang Dong, Yabin Liu, Jian Shen, Cheng Ni, Kan Wang, Zexin Chen, Haibo Chen, Shiqiang Li, Seokhun Yang, Jeehoon Kang, Doyeon Hwang, Joo-Yong Hahn, Chang-Wook Nam, Joon-Hyung Doh, Bong-Ki Lee, Weon Kim, Jinyu Huang, Fan Jiang, Hao Zhou, Peng Chen, Lijiang Tang, Wenbing Jiang, Sung Gyun Ahn, Myeong-Ho Yoon, Ung Kim, Joo Myung Lee, You-Jeong Ki, Eun-Seok Shin, Seung-Jea Tahk, Bon-Kwon Koo, Jun Jiang, Xinyang Hu, Jian'an Wang
CKD was associated with higher PCI and POCO rates, whereas no significant renal function-by-strategy interaction was detected. These exploratory findings require prospective validation. (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis; NCT02673424).
BACKGROUND: A previous FLAVOUR (Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI) trial reported that percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) was noninferior to intravascular ultrasound (IVUS)-guided strategies in terms of the composite outcome of death, myocardial infarction, or revascularization at 24 months (patient-oriented composite outcome [POCO]).
OBJECTIVES: This post hoc secondary analysis of the FLAVOUR trial evaluated the impact of renal dysfunction on lesion characteristics, treatment patterns, and clinical outcomes according to FFR- or IVUS-guided strategies in patients with intermediate coronary stenosis.
METHODS: Patients were classified according to renal function as chronic kidney disease (CKD) or non-CKD. The primary endpoint was POCO.
RESULTS: Among 1,617 patients, 101 (6.2%) had CKD. Compared with non-CKD patients, CKD patients had greater anatomic disease burden on IVUS but similar pre-PCI FFR. CKD patients underwent PCI more frequently (60.4% vs 46.9%; P = 0.009), mainly in the IVUS-guided group, and had a higher POCO rate (17.8% vs 7.8%; P = 0.001). These differences were more evident in PCI-treated patients, whereas deferred lesions showed broadly similar outcomes. No statistically significant differences in outcomes were detected between FFR- and IVUS-guided strategies within renal function strata. Formal interaction analyses showed no significant effect modification by renal function for POCO or any individual endpoint (all P for interaction >0.05).
CONCLUSIONS: CKD was associated with higher PCI and POCO rates, whereas no significant renal function-by-strategy interaction was detected. These exploratory findings require prospective validation. (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis; NCT02673424).