Association of lower fractional flow reserve values with higher risk of adverse cardiac events for lesions deferred revascularization among patients with acute coronary syndrome

BACKGROUND: The safety of deferring revascularization based on fractional flow reserve (FFR) during acute coronary syndrome (ACS) is unclear. We evaluated the association of FFR and adverse cardiac events among patients with coronary lesions deferred revascularization based on FFR in the setting of ACS versus non-ACS. METHODS AND RESULTS: The study population (674 patients; 816 lesions) was divided into ACS (n=334) and non-ACS (n=340) groups based on the diagnosis when revascularization was deferred based on FFR values >0.80 between October 2002 and July 2010. The association and interaction between FFR and clinical outcomes was evaluated using Cox proportional hazards models within each group (mean follow-up of 4.5±2.1 years). Subsequent revascularization of a deferred lesion was classified as a deferred lesion intervention (DLI), whereas the composite of DLI or myocardial infarction (MI) attributed to a deferred lesion was designated as deferred lesion failure (DLF). In the non-ACS group, lower FFR values were not associated with any increase in adverse cardiac events. In the ACS group, every 0.01 decrease in FFR was associated with a significantly higher rate of cardiovascular death, MI, or DLI (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.03 to 1.12), MI or DLI (HR, 1.09; 95% CI: 1.04 to 1.14), DLF (HR, 1.12; 95% CI, 1.06 to 1.18), MI (HR, 1.07; 95% CI, 1.00 to 1.14), and DLI (HR, 1.12; 95% CI, 1.06 to 1.18). CONCLUSION: Lower FFR values among ACS patients with coronary lesions deferred revascularization based on FFR are associated with a significantly higher rate of adverse cardiac events. This association was not observed in non-ACS patients

The corporate brand and strategic direction: Senior business school managers’ cognitions of corporate brand building and management

This revelatory study focuses on top Financial Times (FT) ranked British business school managers cognitions of corporate brand building and management. The study insinuates there is a prima facie bilateral link between corporate branding and strategic direction. Among this genus of business school, the data revealed corporate brand building entailed an on-going concern with strategic management, stakeholder management, corporate communications, service focus, leadership, and commitment. These empirical findings, chime with the early conceptual scholarship on corporate brand management dating back to the mid-1990s. These foundational articles stressed the multi-disciplinary and strategic nature of corporate brand management and stressed the significant role of the CEO. As such, this research adds further credence to the above in terms of best-practice vis-à-vis corporate brand management. Curiously, whilst senior managers espouse a corporate brand orientation, corporate brand management is seemingly not accorded a similar status in the curriculum. Drawing on general embedded case study methodological approach, data was collected within eight leading (FT-ranked) business schools in Great Britain at Oxford, Cambridge, Durham, Bradford, Cranfield, Warwick, Lancaster and City (London) Universities. Each of these eight British business schools can be deemed as ‘top’ business schools by virtue of their inclusion in the influential Financial Times (FT) worldwide list of top business schools. The primary mode of qualitative data collection was the 37 in-depth interviews with business school Deans, Associate Deans and other senior faculty members and other managers