Fractional Flow Reserve Evaluation and Chronic Kidney Disease: Analysis From a Multicenter Italian Registry (the FREAK Study)

• Published in: Catheterization and cardiovascular interventions 2016-10, Vol.88 (4), p.555-562
• Main Authors: Tebaldi, Matteo, Biscaglia, Simone, Fineschi, Massimo, Manari, Antonio, Menozzi, Mila, Secco, Gioel Gabrio, Di Lorenzo, Emilio, D'Ascenzo, Fabrizio, Fabbian, Fabio, Tumscitz, Carlo, Ferrari, Roberto, Campo, Gianluca
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biomarkers - blood; Cardiac Catheterization; Cardiovascular disease; Coronary Angiography; coronary artery disease; Coronary Stenosis - diagnosis; Coronary Stenosis - physiopathology; Coronary Stenosis - therapy; Creatinine - blood; Female; Fractional Flow Reserve, Myocardial; Glomerular Filtration Rate; Humans; Italy; Kidney - physiopathology; Kidney diseases; Male; Microcirculation; microvascular function; Middle Aged; Myocardial Revascularization; Predictive Value of Tests; Prospective Studies; Registries; renal failure; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Severity of Illness Index; Vascular Resistance
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26364

Objectives To establish if the presence of chronic kidney disease (CKD) influences fractional flow reserve (FFR) value in patients with intermediate coronary stenosis. Background FFR‐guided coronary revascularization reduces cardiac adverse events in patients with coronary artery disease. CKD impairs microcirculation and increases cardiovascular risk. Whether CKD presence may limit FFR accuracy is unknown. Methods We used data from a multicenter prospective registry enrolling 1.004 patients undergoing FFR evaluation for intermediate stenosis. We assessed the relationship between clinical and angiographic variables and FFR measurement. CKD was defined as CrCl value ≤45 ml/min. FFR value was considered potentially flow‐limiting, and therefore positive, if ≤0.80. The index of microcirculatory resistance (IMR) was calculated in 20 patients stratified according CrCl value (single‐center substudy). Results: FFR measurement was positive in 395 (39%) patients. Overall, 131 (13%) patients had CKD. Patients with CrCl ≤45 ml/min showed significantly higher FFR values as compared to the others (0.84 ± 0.07 vs. 0.81 ± 0.08, p