Prognostic Impact of Renal Function on Outcomes After Physiology-Guided Coronary Revascularization: Insights From the J-PRIDE Registry.

IF 7.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Interventions Pub Date : 2026-04-27 DOI:10.1161/CIRCINTERVENTIONS.125.016454

Hirofumi Ohashi, Shoichi Kuramitsu, Hirohiko Ando, Tomohiro Shinozaki, Yoshiaki Kawase, Takenori Domei, Futoshi Yamanaka, Umihiko Kaneko, Tsunekazu Kakuta, Kazunori Horie, Hidenobu Terai, Yasutsugu Shiono, Toru Tagashira, Kazutaka Nogi, Takashi Kubo, Taku Asano, Jun Shiraishi, Hiromasa Otake, Akinori Sugano, Hiroki Okabe, Atsushi Iwai, Yuetsu Kikuta, Hidetaka Nishina, Masashi Iwabuchi, Hiroyoshi Yokoi, Takashi Akasaka, Hitoshi Matsuo, Nobuhiro Tanaka, Tetsuya Amano

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引用次数: 0

Abstract

Background: The clinical utility of physiology-guided revascularization for decision-making in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) remains uncertain. The aim of this study is to evaluate the diagnostic performance and prognostic significance of fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs) according to the severity of CKD.

Methods: This subanalysis of the J-PRIDE registry, a prospective multicenter study conducted at 20 Japanese centers between September 2019 and February 2021, included 4296 lesions from 3194 patients who underwent both FFR and NHPR assessment. Patients were categorized by estimated glomerular filtration rate into non-CKD (≥60 mL/min per 1.73 m²; n=1639), CKD (15-59; n=1321), and ESRD (<15 or on dialysis; n=234). The primary end point was 1-year target vessel failure, defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization.

Results: The 1-year incidence of target vessel failure was significantly higher in the ESRD group than in CKD and non-CKD groups (8.4% versus 2.4% and 2.6%; for CKD, adjusted hazard ratio, 3.09 [95% CI, 1.60-5.96]; P<0.001; for non-CKD, adjusted hazard ratio, 2.88 [95% CI, 1.98-5.47]; P=0.001). The NHPR cutoff predicting FFR ≤0.80 was lower in ESRD compared with CKD and non-CKD (0.85 versus 0.89 versus 0.89). Although the overall prevalence of FFR/NHPR discordance was comparable (23.6%, 19.7%, and 19.7%; P=0.24), FFR-/NHPR+ discordance predominated in ESRD (18.6% versus 9.3% versus 7.0%; P<0.001). FFR-/NHPR+ lesions in the ESRD group exhibited an excess risk compared with other lesions. Revascularization was beneficial in non-CKD patients with FFR+/NHPR- lesions, whereas no clear benefit was observed in patients with CKD and ESRD.

Conclusions: Patients with ESRD exhibited distinct physiological characteristics and substantially worse outcomes, highlighting the need for tailored coronary revascularization strategies in this population.

Registration: URL: https://www.umin.ac.jp/ctr; Unique identifier: UMIN000038403.

查看原文本刊更多论文

生理引导冠状动脉血运重建术后肾功能对预后的影响：来自J-PRIDE登记的见解。

背景：生理引导的血运重建术在慢性肾脏疾病（CKD）和终末期肾脏疾病（ESRD）患者决策中的临床应用仍不确定。本研究的目的是根据CKD的严重程度评价分数血流储备（FFR）和非充血压比（nhpr）的诊断价值和预后意义。J-PRIDE登记是一项前瞻性多中心研究，于2019年9月至2021年2月在日本20个中心进行，包括3194名患者的4296个病变，这些患者接受了FFR和NHPR评估。根据估计的肾小球滤过率将患者分为非CKD（≥60 mL/min / 1.73 m2; n=1639）、CKD （15-59; n=1321）和ESRD(结果：ESRD组1年靶血管衰竭发生率显著高于CKD和非CKD组（8.4% vs 2.4%和2.6%；CKD校正风险比为3.09 [95% CI, 1.60-5.96]； PP=0.001）。与CKD和非CKD相比，ESRD中预测FFR≤0.80的NHPR截止值较低（0.85比0.89比0.89）。尽管FFR/NHPR不一致的总体患病率是相当的（23.6%，19.7%和19.7%；P=0.24），但FFR-/NHPR+不一致在ESRD中占主导地位（18.6%对9.3%对7.0%）。结论：ESRD患者表现出明显的生理特征和更差的结果，突出了在这一人群中需要定制冠状动脉血流重建策略。注册：网址：https://www.umin.ac.jp/ctr；唯一标识符：UMIN000038403。

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来源期刊

Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

1.80%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.