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Age and Functional Relevance of Coronary Stenosis: a Post-Hoc Analysis of the ADVISE II Trial
Session:
CO 01 - Doença coronária
Speaker:
Daniel Faria
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Daniel Candeias Faria; Joo Myung Lee; Tim Van Der Hoef; Hernán Mejía-Rentería; Mauro Echavarría-Pinto; Sérgio Bravo Baptista; Enrico Cerrato; Hector García-García; Justin Davies; Yoshinobu Onuma; Habib Samady; Jan j Piek; Patrick w Serruys; Amir Lerman; Javier Escaned
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Aims</strong>: The influence of age-dependent changes on fractional flow reserve (FFR) or instantaneous free-wave ratio (iFR) and the response to pharmacological hyperaemia has not been investigated. We investigated the impact of age on these indices.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Methods and Results</strong>: This is as post-hoc analysis of the ADVISE II trial, including a total of 690 pressure recordings (in 591 patients). Age-dependent correlations with FFR and iFR were calculated and adjusted for stenosis severity. Patients were stratified into three age terciles. The hyperaemic response to adenosine, calculated as the difference between resting and hyperaemic pressure ratios, and the prevalence of FFR-iFR discordance were assessed.<strong> </strong></span>Correlations between coronary physiology indices and age were adjusted for several potential cofounders, including: visual lesion severity, interrogated target vessel with proximal LAD artery lesion, presence of hypertension, diabetes, renal failure, number of vessels interrogated per patient and patients presenting with an ACS. <span style="font-family:Calibri,sans-serif">Age correlated positively with FFR (r<sup>2</sup>=0.08, 95% CI: 0.01 to 0.15, p=0.015), but not with iFR (r<sup>2</sup>=-0.03, 95% CI: -0.11 to 0.04, p=0.411) - Figure A. The hyperaemic response to adenosine decreased with patient age (0.12 ± 0.07, 0.11 ± 0.06, 0.09 ± 0.05, for the 1<sup>st</sup>[33-58 years], 2<sup>nd</sup>[59-69 years] and 3<sup>rd</sup>[70-94 years] age tertiles, respectively, p<0.001) and showed significant correlation with age (r<sup>2</sup>=-0.14, 95% CI -0.21 to -0.06, p<0.001). The proportion of patients with FFR≤0.80 + iFR>0.89 discordance doubled in the first age-tercile (14.1% vs 7.1% vs 7.0%, p=0.005)- Figure B. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Conclusions</strong>: The hyperaemic response of the microcirculation to adenosine administration is age-dependent. FFR values increase with patient age, while iFR values remain constant across the age spectrum. These findings contribute to explain differences observed in functional stenosis classification with hyperaemic and non-hyperaemic coronary indices.</span></span></p>
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