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RISS 인기검색어
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- 저자 : Molony, David S. (검색결과 1 건)
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High Coronary Shear Stress in Patients With Coronary Artery Disease Predicts Myocardial Infarction
Kumar, Arnav,Thompson, Elizabeth W.,Lefieux, Adrien,Molony, David S.,Davis, Emily L.,Chand, Nikita,Fournier, Stephane,Lee, Hee Su,Suh, Jon,Sato, Kimi,Ko, Yi-An,Molloy, Daniel,Chandran, Karthic,Hossein Elsevier 2018 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY - Vol.72 No.16
<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Coronary lesions with low fractional flow reserve (FFR) that are treated medically are associated with higher revascularization rates. High wall shear stress (WSS) has been linked with increased plaque vulnerability.</P> <P><B>Objectives</B></P> <P>This study investigated the prognostic value of WSS measured in the proximal segments of lesions (WSS<SUB>prox</SUB>) to predict myocardial infarction (MI) in patients with stable coronary artery disease (CAD) and hemodynamically significant lesions. The authors hypothesized that in patients with low FFR and stable CAD, higher WSS<SUB>prox</SUB> would predict MI.</P> <P><B>Methods</B></P> <P>Among 441 patients in the FAME II (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation II) trial with FFR ≤0.80 who were randomized to medical therapy alone, 34 (8%) had subsequent MI within 3 years. Patients with vessel-related MI and adequate angiograms for 3-dimensional reconstruction (n = 29) were propensity matched to a control group with no MI (n = 29) by using demographic and clinical variables. Coronary lesions were divided into proximal, middle, and distal, along with 5-mm upstream and downstream segments. WSS was calculated for each segment.</P> <P><B>Results</B></P> <P>Median age was 62 years, and 46 (79%) were male. In the marginal Cox model, whereas lower FFR showed a trend (hazard ratio: 0.084; p = 0.064), higher WSS<SUB>prox</SUB> (hazard ratio: 1.234; p = 0.002, C-index = 0.65) predicted MI. Adding WSS<SUB>prox</SUB> to FFR resulted in a significant increase in global chi-square for predicting MI (p = 0.045), a net reclassification improvement of 0.69 (p = 0.005), and an integrated discrimination index of 0.11 (p = 0.010).</P> <P><B>Conclusions</B></P> <P>In patients with stable CAD and hemodynamically significant lesions, higher WSS in the proximal segments of atherosclerotic lesions is predictive of MI and has incremental prognostic value over FFR.</P> <P><B>Central Illustration</B></P> <P>[DISPLAY OMISSION]</P>
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