Background
Computed tomography fractional flow reserve (CT-FFR), which can be acquired on-site workstation using fluid structure interaction during the multiple optimal diastolic phase, has an incremental diagnostic value over conventional coronary computed tomography angiography (CCTA). However, the appropriate location for CT-FFR measurement remains to be clarified.
Method
A total of 115 consecutive patients with 149 vessels who underwent CCTA showing 30–90% stenosis with invasive FFR within 90 days were retrospectively analyzed. CT-FFR values were measured at three points: 1 and 2 cm distal to the target lesion (CT-FFR
1cm, 2cm
) and the vessel terminus (CT-FFR
lowest
). The diagnostic accuracies of CT-FFR ≤ 0.80 for detecting hemodynamically significant stenosis, defined as invasive FFR ≤ 0.80, were compered.
Result
Fifty-five vessels (36.9%) had invasive FFR ≤ 0.80. The accuracy and AUC for CT-FFR
1cm
and
2cm
were comparable, while the AUC for CT-FFR
lowest
was significantly lower than CT-FFR
1cm
and
2cm
. (lowest/1cm, 2 cm = 0.68 (95 %CI 0.63–0.73) vs 0.79 (0.72–0.86, p = 0.006), 0.80 (0.73–0.87, p = 0.002)) The sensitivity and negative predictive value of CT-FFR
lowest
were 100%. The reclassification rates from positive CT-FFR
lowest
to negative CT-FFR
1cm
and
2cm
were 55.7% and 54.2%, respectively.
Conclusion
The diagnostic performance of CT-FFR was comparable when measured at 1-to-2 cm distal to the target lesion, but significantly higher than CT-FFR
lowest
. The lesion-specific CT-FFR could reclassify false positive cases in patients with positive CT-FFR
lowest
, while all patients with negative CT-FFR
lowest
were diagnosed as negative by invasive FFR.
Aims
Living alone is reported as an independent risk factor for cardiovascular disease. However, little is known about the association between clinical outcomes and living alone in patients with acute coronary syndrome (ACS). The aim of this study was to determine whether living alone is an independent prognostic risk factor for long-term mortality stratified by age in patients with ACS who were treated with primary percutaneous coronary intervention (PCI).
Methods and results
We conducted an observational cohort study of ACS patients who underwent PCI between January 1999 and May 2015 at Juntendo University Shizuoka Hospital, Japan. The primary endpoint was all-cause death. Among 2547 ACS patients, 381 (15.0%) patients were living alone at the onset of ACS. The cumulative incidence of all-cause death was comparable between living alone and living together (34.8% vs. 34.4%, log-rank P = 0.63). However, among younger population (aged <65 years), the incidence of all-cause death was significantly higher in the living alone group (log-rank P = 0.01). Multivariate Cox hazard analysis revealed a significant association between living alone and all-cause death, even after adjusting for other risk factors (hazard ratio 2.30, 95% confidence interval 1.38–3.84, P = 0.001).
Conclusion
Although living alone was not significantly associated with long-term clinical outcomes in patients with ACS, it was a predictive risk factor among younger ACS patients. Careful attention should be paid to patients’ lifestyle, especially younger patients with ACS.
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