Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Feb 2020)

Sex Differences in Long‐Term Outcomes in Patients With Deferred Revascularization Following Fractional Flow Reserve Assessment: International Collaboration Registry of Comprehensive Physiologic Evaluation

  • Masahiro Hoshino,
  • Rikuta Hamaya,
  • Yoshihisa Kanaji,
  • Yoshinori Kanno,
  • Masahiro Hada,
  • Masao Yamaguchi,
  • Yohei Sumino,
  • Hidenori Hirano,
  • Tomoki Horie,
  • Eisuke Usui,
  • Tomoyo Sugiyama,
  • Tadashi Murai,
  • Tetsumin Lee,
  • Taishi Yonetsu,
  • Joo Myung Lee,
  • Ki Hong Choi,
  • Doyeon Hwang,
  • Jonghanne Park,
  • Ji‐Hyun Jung,
  • Hyung Yoon Kim,
  • Hae Won Jung,
  • Yun‐Kyeong Cho,
  • Hyuck‐Jun Yoon,
  • Young Bin Song,
  • Joo‐Yong Hahn,
  • Joon‐Hyung Doh,
  • Chang‐Wook Nam,
  • Eun‐Seok Shin,
  • Seung‐Ho Hur,
  • Hernán Mejía‐Rentería,
  • Francesco Lauri,
  • Sonoka Goto,
  • Fernando Macaya,
  • Angela McInerney,
  • Giacomo Gravina,
  • Rafael Vera,
  • Nieves Gonzalo,
  • Pilar Jimenez‐Quevedo,
  • Ivan Nuñez‐Gil,
  • Pablo Salinas,
  • Luis Nombela‐Franco,
  • Maria del Trigo,
  • Antonio Fernández‐Ortiz,
  • Carlos Macaya,
  • Bon‐Kwon Koo,
  • Javier Escaned,
  • Tsunekazu Kakuta

DOI
https://doi.org/10.1161/JAHA.119.014458
Journal volume & issue
Vol. 9, no. 4

Abstract

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Background Sex‐specific differences may influence prognosis after deferred revascularization following fractional flow reserve (FFR) measurement. This study sought to investigate the sex differences in long‐term prognosis of patients with deferred revascularization following FFR assessment. Methods and Results A total of 879 patients (879 vessels) with deferred revascularization with FFR >0.75 who underwent FFR and coronary flow reserve measurements were enrolled from 3 countries (Korea, Japan, and Spain). Long‐term outcomes were assessed in 649 men and 230 women by the patient‐oriented composite outcome (POCO, a composite of any death, any myocardial infarction, and any revascularization). We applied inverse‐probability weighting based on propensity scores to account for differences at baseline between women and men (age, hyperlipidemia, diabetes mellitus, diameter stenosis, lesion length, multivessel disease, FFR, coronary flow reserve. The median follow‐up duration was 1855 days (745–1855 days). Median FFR values were 0.88 (0.83–0.93) in men and 0.89 (0.85–0.94) in women, respectively. The occurrences of POCO were significantly high in men compared with that in women (10.5% versus 4.2%, P=0.007). Kaplan–Meier analysis revealed that women had a significantly lower risk of POCO (χ2=7.2, P=0.007). Multivariate COX proportional hazards regression analysis revealed that age, male, diabetes mellitus, diameter stenosis, lesion length, and coronary flow reserve were independent predictors of POCO. After applying IPW, the hazard ratio of males for POCO was 2.07 (95% CI, 1.07–4.04, P=0.032). Conclusions This large multinational study reveals that long‐term outcome differs between women and men in favor of women after FFR‐guided revascularization deferral. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT02186093.

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