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Sex-based difference in fractional flow reserve and its impact on clinical outcomes - 30/10/21

Doi : 10.1016/j.ahj.2021.08.010 
Mohammad Alkhalil, DPhil, MRCP a, b, , Gavin Thomas, MBBCh, MRCP a, c, Mark S. Spence, MBBCh, FRCP a, Colum Owens, MBBCh, MD a, Peter McKavanagh, MBBCh, BAO, PhD a, c
a Department of Cardiology, Royal Victoria Hospital, Belfast UK 
b Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK 
c Department of Cardiology, Ulster Hospital, Belfast UK 

Reprint requests: Mohammad Alkhalil DPhil, MRCP, Department of Cardiothoracic Services, Freeman Hospital, Newcastle-upon-Tyne, UK Tel: + 0191-233-6161.Department of Cardiothoracic ServicesFreeman HospitalNewcastle-upon-TyneUK

Riassunto

Background

Obesity is a real public health problem and is of growing concern. People are resorting to surgical or endoscopic means to fight against overweight and obesity. In recent years, there has been a marked increase in the use of these means and in particular the insertion of a gastric balloon which seems to present less risk than surgical methods. Renal complications from intragastric balloon placement are extremely rare. We report here the case of compression of the left renal vein revealed by lumbar pain and hematuria in an overweight 39-year-old woman who benefited from the balloon gastric placement one month before symptoms. The scanner made the diagnosis and showed a good evolution after the withdrawal of the balloon.

Methods

This was a prespecified and retrospective analysis of all consecutive patients who underwent FFR assessment for intermediate coronary lesions between January 2014 and December 2015. The primary endpoint was defined as the 1-year composite of cardiac death, vessel-related myocardial infarction, and clinically-driven target vessel revascularization.

Results

In 1554 lesions (23% in women), FFR was lower in men [0.83 ±0.09 vs 0.85 ±0.08, P = .004] driven by LAD values (for LAD P < .001, LCx or RCA P> .40). In proximal lesions (PLs), FFR was lower in men [0.83 ±0.10 vs 0.85 ±0.08, P = .004] with comparable values in non-PLs [0.84 ±0.09 vs 0.85 ±0.08, P = .36]. In PLs, the primary endpoint was higher in women [HR(adjusted) 3.18 (1.08-9.37), P = .035] with comparable outcomes in non-PLs (P = .032 for interaction). In deferred lesions, the primary endpoint was higher in women [HR(adjusted) 2.73 (1.10-6.74), P = .03] with no differences in revascularized lesions across sex (P = .02 for interaction). Results were consistent when using propensity score matching analysis.

Conclusions

There is a sex-based difference in FFR, particularly in stenoses subtending large myocardium, and more evident in deferred lesions.

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© 2021  Pubblicato da Elsevier Masson SAS.
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P. 24-32 - Dicembre 2021 Ritorno al numero
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