Prognostic Impact of Renal Function on 5‐Year Outcomes After Fractional Flow Reserve‐Guided Deferral of Revascularization

Abstract

Background Chronic kidney disease (CKD) might influence fractional flow reserve (FFR) value, potentially attenuating its prognostic utility. However, few large‐scale data are available regarding clinical outcomes after FFR‐guided deferral of revascularization in patients with CKD. Methods and Results From the J‐CONFIRM registry (Long‐Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), 1218 patients were divided into 3 groups according to renal function: (1) non‐CKD (estimated glomerular filtration rate ≥60 mL/min per 1.73 m 2 ), n=385; (2) CKD (estimated glomerular filtration rate 15–59 mL/min per 1.73 m 2 , n=763); and (3) end‐stage renal disease (ESRD) (eGFR <15 mL/min per 1.73 m 2 , n=70). The primary study end point was the cumulative 5‐year incidence of target vessel failure (TVF), defined as a composite of cardiac death, target vessel myocardial infarction, and clinical driven target vessel revascularization. Cumulative 5‐year incidence of TVF was significantly higher in the ESRD group than in the CKD and non‐CKD group, whereas it did not differ between the CKD and non‐CKD groups (26.3% versus 11.9% versus 9.5%, P <0.001). Although the 5‐year TVF risk increased as the FFR value decreased regardless of renal function, patients with ESRD had a remarkably higher risk of TVF at every FFR value than those with CKD and non‐CKD. Conclusions At 5 years, patients with ESRD showed a higher incidence of TVF than patients with CKD and non‐CKD, although with similar outcomes between patients with CKD and non‐CKD. Patients with ESRD had an excess risk of 5‐year TVF at every FFR value compared with those with CKD and non‐CKD. Registration URL: https://www.umin.ac.jp ; Unique identifier: UMIN000014473.