Long-term follow-up after deferral of coronary intervention based on myocardial fractional flow reserve measurement
Bibliographic record
Abstract
In Brief Objective To assess long-term results after deferring coronary intervention (percutaneous coronary intervention (PCI)) of an intermediate lesion with a value of myocardial fractional flow reserve (FFR) ≥0.75 in a ‘real life’ patient population with no respect to results of stress tests (if performed) or coronary disease extent. Methods PCI of an intermediate lesion was deferred in a group of 85 consecutive patients (54 men, 61±10 years) on the basis of the result of FFR ≥0.75 (mean FFR, 0.89±0.06%). FFR was measured in 111 stenoses (mean diameter stenosis, 54±8%, left anterior descending coronary artery, 65 (58%), left circumflex coronary artery, 24 (22%), right coronary artery, 22 (20%). Multi-vessel disease (defined as visually assessed diameter reduction of more than 50% in at least two arteries of more than 1.5 mm diameter, supplying at least two of the three major coronary artery perfusion territories) was present in 67% of patients (one-vessel disease, 28 patients (33%), two-vessel disease, 39 patients (46%), three-vessel disease, 18 patients (21%). Recorded events during follow-up were as follows: all-cause death, cardiac death, non-fatal myocardial infarction, ischemia-driven target lesion transcatheter revascularization (TLR) and coronary artery bypass graft (CABG). Angina class (Canadian Cardiovascular Society (CCS) classification) and the need for anti-anginal drugs were recorded. Results Follow-up was completed in 85 patients (100%). Mean duration of follow-up was 22.6±6.6 months (range 4–33 months). Events occurred in 11 patients (13%). Seven patients died; this included two cardiac deaths. A non-fatal myocardial infarction occurred in one patient, one patient needed TLR and three patients underwent CABG. Estimated 33 month cardiac-event-free survival (Kaplan–Meier) was 91±4%. Angina class decreased [1.6±1.2 compared with 0.8±0.8 (P<0.0001)] without difference with respect to the use of anti-anginal drugs (1.7±0.8 compared with 1.7±0.9, P=NS). Conclusions Deferring coronary interventions of intermediate stenosis based on FFR measurement is safe with respect to long-term follow-up, irrespective of the extent of coronary artery disease. The aim of the study was to assess long-term results after FFR guided deferral of coronary intervention (PCI) of intermediate stenosis in a “real life” non-selected patient population. PCI of a total of 111 intermediate stenosis with FFR=0.75 was deferred in 85 patients. Mortality and cardiac events were recorded during follow-up of 22.6±6.6 months (range 4-33 months). Events occurred in 11 patients (13%). Seven patients died, including 2 cardiac deaths, non-fatal MI in 1 patient and 3 patients underwent CABG. Estimated 33-months cardiac event-free survival (Kaplan-Mayer) was 91±4%.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".