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Residual functional SYNTAX score by quantitative flow ratio and improvement of exercise capacity after revascularization
Author(s) -
Lee Seung Hun,
Choi Ki Hong,
Lee Joo Myung,
Shin Doosup,
Hwang Doyeon,
Kim Hyun Kuk,
Doh JoonHyung,
Nam ChangWook,
Shin EunSeok,
Jang Mi Ja,
Im Se Young,
Park Taek Kyu,
Yang Jeong Hoon,
Song Young Bin,
Hahn JooYong,
Choi SeungHyuk,
Koo BonKwon,
Gwon HyeonCheol
Publication year - 2021
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.29118
Subject(s) - conventional pci , medicine , cardiology , revascularization , percutaneous coronary intervention , myocardial infarction
Objectives This study aimed to evaluate the association between improvement in exercise capacity and functional completeness of revascularization, determined by residual functional SYNTAX score (rFSS), which is the sum of residual SYNTAX score of the vessels with post‐ percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) ≤0.80. Background In patients with stable ischemic heart disease (SIHD), the efficacy of PCI in improving exercise capacity has been under debate and the differential effect of PCI for exercise capacity, according to functional completeness of revascularization, has not been evaluated. Methods Among patients enrolled in the QFR multicenter registry, 110 patients who underwent routine exercise treadmill tests before and after PCI were analyzed. Patients were classified into functional complete revascularization (CR) group (rFSS = 0) and functional incomplete revascularization (IR) group (rFSS ≥ 1). Increase of exercise time after PCI was compared between the two groups. Improvement of exercise capacity was defined as ≥10% increase of exercise time after PCI. Results Functional CR was achieved in 79 patients (71.8%), otherwise classified as functional IR in 31 patients (28.2%) without differences in baseline characteristics including medication profiles. Increase of exercise time was significantly associated with increase of 3‐vessel QFR (sum of QFRs in all three vessels; r = .198, p = .038) and rFSS ( r = −.312, p < .001), but not with decrease of SYNTAX score ( r = .097, p = .313). The rFSS showed significantly higher c‐index to predict the improvement of exercise capacity after PCI than increase of 3‐vessel QFR or decrease of SYNTAX score (0.722 vs. 0.627 vs. 0.492, respectively, p < 0.001). Patients with functional CR, defined by rFSS, showed significantly higher absolute and relative increase in exercise time than those with functional IR (97.7 s vs. 12.5 s, p < .001; 25.4% vs. 3.6%, p = .001). Functional CR was an independent predictor for improvement of exercise capacity after PCI (adjusted OR 4.656, 95% CI 1.678–12.920, p = .002). Conclusions Integrated anatomic and functional scoring system (rFSS) was significantly associated with improvement of exercise capacity after PCI. SIHD patients with functional CR, defined by rFSS, showed significantly higher exercise capacity after PCI than those with functional IR.