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Fractional Flow Reserve Evaluation and Chronic Kidney Disease: Analysis From a Multicenter I talian Registry (the FREAK Study)
Author(s) -
Tebaldi Matteo,
Biscaglia Simone,
Fineschi Massimo,
Manari Antonio,
Menozzi Mila,
Secco Gioel Gabrio,
Di Lorenzo Emilio,
D'Ascenzo Fabrizio,
Fabbian Fabio,
Tumscitz Carlo,
Ferrari Roberto,
Campo Gianluca
Publication year - 2016
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26364
Subject(s) - medicine , fractional flow reserve , kidney disease , cardiology , coronary artery disease , renal function , revascularization , prospective cohort study , stenosis , urology , coronary angiography , myocardial infarction
Objectives To establish if the presence of chronic kidney disease (CKD) influences fractional flow reserve (FFR) value in patients with intermediate coronary stenosis. Background FFR‐guided coronary revascularization reduces cardiac adverse events in patients with coronary artery disease. CKD impairs microcirculation and increases cardiovascular risk. Whether CKD presence may limit FFR accuracy is unknown. Methods We used data from a multicenter prospective registry enrolling 1.004 patients undergoing FFR evaluation for intermediate stenosis. We assessed the relationship between clinical and angiographic variables and FFR measurement. CKD was defined as CrCl value ≤45 ml/min. FFR value was considered potentially flow‐limiting, and therefore positive, if ≤0.80. The index of microcirculatory resistance (IMR) was calculated in 20 patients stratified according CrCl value (single‐center substudy). Results: FFR measurement was positive in 395 (39%) patients. Overall, 131 (13%) patients had CKD. Patients with CrCl ≤45 ml/min showed significantly higher FFR values as compared to the others (0.84 ± 0.07 vs. 0.81 ± 0.08, p < 0.001). Positive FFR occurrence was lower in patients with CrCl ≤45 ml/min (27% vs. 41%, p < 0.01). After multivariable analysis, diabetes (HR 1.07, 95%CI 1.008–1.13, p = 0.03), left anterior descending (HR 1.35, 95%CI 1.27–1.43, p < 0.001) and CrCl ≤45 ml/min (HR 0.92, 95%CI 0.87–0.97, p = 0.005) emerged as independent predictors of FFR measurement. Accordingly, IMR values were higher in patients with CrCl ≤45 ml/min (32 U [28245] vs. 16 U [11220], p < 0.01). Conclusions FFR and IMR measurements differ between CKD patients and those with normal renal function. Flow‐limiting FFR is less frequent in patients with CrCl ≤45 ml/min. © 2015 Wiley Periodicals, Inc.