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

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: ; 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: <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.

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Journal
Circulation Cardiovascular Interventions
Published
2026-04-27
DOI
https://doi.org/10.1161/circinterventions.125.016454
Primary Topic
Coronary Interventions and Diagnostics
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article
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article

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

Takashi Akasaka, Tsunekazu Kakuta, Takenori Domei, Yuetsu Kikuta et al.
Circulation Cardiovascular Interventions
Coronary Interventions and Diagnostics
article

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

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

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: ; 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: <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.

Circulation Cardiovascular Interventions
National Archives and Records Administration (US), Aichi Medical University (JP), University of Occupational and Environmental Health Japan (JP), Wakayama Medical University (JP), University of the Ryukyus (JP), St. Luke's International Hospital (JP), Tsuchiura Kyodo General Hospital (JP), Tokyo Medical University Hachioji Medical Center (JP), Sapporo Science Center (JP), Tokyo-Kita Medical Center (JP), Fukuyama Cardiovascular Hospital (JP), Sakurabashi Watanabe Hospital (JP), Ibaraki Prefectural Central Hospital (JP), Tsukuba Medical Center Hospital (JP), Shonan Kamakura General Hospital (JP), Japanese Red Cross Society Kyoto Daini Hospital (JP), Gifu Heart Center (JP), University of the Ryukyus University Hospital (JP), Kanazawa Hospital (JP), Kokura Memorial Hospital (JP), Sanno Medical Center (JP), Sendai Kousei Hospital (JP), Nara Medical University (JP), Kobe University (JP)
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Openalex Percentile: Top 13%
Coronary Interventions and Diagnostics
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