Risk model for estimating the 1-year risk of deferred lesion intervention following deferred revascularization after fractional flow reserve assessment

Jeremiah P. Depta, Jayendrakumar S. Patel, Eric Novak, Brian F. Gage, Shriti K. Masrani, David Raymer, Gabrielle Facey, Yogesh Patel, Alan Zajarias, John M. Lasala, Amit P. Amin, Howard I. Kurz, Jasvindar Singh, Richard G. Bach

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Aims Although lesions deferred revascularization following fractional flow reserve (FFR) assessment have a low risk of adverse cardiac events, variability in risk for deferred lesion intervention (DLI) has not been previously evaluated. The aim of this study was to develop a prediction model to estimate 1-year risk of DLI for coronary lesions where revascularization was not performed following FFR assessment. Methods and results A prediction model for DLI was developed from a cohort of 721 patients with 882 coronary lesions where revascularization was deferred based on FFR between 10/2002 and 7/2010. Deferred lesion intervention was defined as any revascularization of a lesion previously deferred following FFR. The final DLI model was developed using stepwise Cox regression and validated using bootstrapping techniques. An algorithm was constructed to predict the 1-year risk of DLI. During a mean (±SD) follow-up period of 4.0 ± 2.3 years, 18% of lesions deferred after FFR underwent DLI; the 1-year incidence of DLI was 5.3%, while the predicted risk of DLI varied from 1 to 40%. The final Cox model included the FFR value, age, current or former smoking, history of coronary artery disease (CAD) or prior percutaneous coronary intervention, multi-vessel CAD, and serum creatinine. The c statistic for the DLI prediction model was 0.66 (95% confidence interval, CI: 0.61-0.70). Conclusion Patients deferred revascularization based on FFR have variation in their risk for DLI. A clinical prediction model consisting of five clinical variables and the FFR value can help predict the risk of DLI in the first year following FFR assessment.

Original languageEnglish
Pages (from-to)509-515
Number of pages7
JournalEuropean heart journal
Volume36
Issue number8
DOIs
StatePublished - Feb 21 2015

Keywords

  • Deferred lesion intervention
  • Fractional flow reserve

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