TY - JOUR
T1 - Predictors of fractional flow reserve/instantaneous wave-free ratio discordance: impact of tailored diagnostic cut-offs on clinical outcomes of deferred lesions
AU - De Filippo, Ovidio
AU - Gallone, Guglielmo
AU - D'Ascenzo, Fabrizio
AU - D'Ascenzo, Francesca
AU - Leone, Antonio Maria
AU - Mancone, Massimo
AU - Quadri, Giorgio
AU - Barbieri, Lucia
AU - Barbieri, Laura
AU - Bossi, Irene
AU - Boccuzzi, Giacomo
AU - Montone, Rocco Antonio
AU - Burzotta, Francesco
AU - Iannaccone, Mario
AU - Iannaccone, Marco
AU - Montefusco, Antonio
AU - Carugo, Stefano
AU - Castelli, Chiara
AU - Oreglia, Jacopo
AU - Cerrato, Enrico
AU - Peirone, Andrea
AU - Zaccardo, Giuseppe
AU - Sardella, Gennaro
AU - Niccoli, Giampaolo
AU - Omedè, Pierluigi
AU - Varbella, Ferdinando
AU - Rognoni, Andrea
AU - Trani, Carlo
AU - Conrotto, Federico
AU - Escaned, Javier
AU - De Ferrari, Gaetano Maria
PY - 2022
Y1 - 2022
N2 - BACKGROUND: Patient-related and lesion-related factors may influence instantaneous wave-free ratio (iFR)/fractional flow reserve (FFR) concordance, potentially affecting the safety of revascularization deferral. METHODS: Consecutive patients with at least an intermediate coronary stenosis evaluated by both iFR and FFR were retrospectively enrolled. The agreement between iFR and FFR at their diagnostic cut-offs (FFR 0.80, iFR 0.89) was assessed. Predictors of discordance were assessed using multivariate analyses. Tailored iFR cut-offs according to predictors of discordance best matching an FFR of 0.80 were identified. The impact of reclassification according to tailored iFR cut-offs on major cardiovascular events (MACE: cardiovascular death, myocardial infarction or target-lesion revascularization) among deferred lesions was investigated. RESULTS: Two hundred and ninety-nine intermediate coronary stenosis [FFR 0.84 (0.78-0.89), iFR 0.91 (0.87-0.95), 202 left main/left anterior descending (LM/LAD) vessels, 67.6%] of 260 patients were studied. Discordance rate was 23.4% (n = 70, 10.7% iFR-negative discordant, 12.7% iFR-positive discordant). Predictors of discordance were LM/LAD disease, multivessel disease, non-ST-elevation myocardial infarction, smoking, reduced eGFR and hypertension. Lesion reclassification with tailored iFR cut-offs based on patient-level predictors carried no prognostic value among deferred lesions. Reclassification according to lesion location, which was entirely driven by LM/LAD lesions (iFR cut-offs: 0.93 for LM/LAD, 0.89 for non-LM/LAD), identified increased MACE among lesions deferred based on a negative FFR, between patients with a positive as compared with a negative iFR (19.4 vs. 6.1%, P = 0.044), whereas the same association was not observed with the conventional 0.89 iFR cut-off (15 vs. 8.6%, P = 0.303). CONCLUSION: Tailored vessel-based iFR cut-offs carry prognostic value among FFR-negative lesions, suggesting that a one-size-fit-all iFR cut-off might be clinically unsatisfactory.
AB - BACKGROUND: Patient-related and lesion-related factors may influence instantaneous wave-free ratio (iFR)/fractional flow reserve (FFR) concordance, potentially affecting the safety of revascularization deferral. METHODS: Consecutive patients with at least an intermediate coronary stenosis evaluated by both iFR and FFR were retrospectively enrolled. The agreement between iFR and FFR at their diagnostic cut-offs (FFR 0.80, iFR 0.89) was assessed. Predictors of discordance were assessed using multivariate analyses. Tailored iFR cut-offs according to predictors of discordance best matching an FFR of 0.80 were identified. The impact of reclassification according to tailored iFR cut-offs on major cardiovascular events (MACE: cardiovascular death, myocardial infarction or target-lesion revascularization) among deferred lesions was investigated. RESULTS: Two hundred and ninety-nine intermediate coronary stenosis [FFR 0.84 (0.78-0.89), iFR 0.91 (0.87-0.95), 202 left main/left anterior descending (LM/LAD) vessels, 67.6%] of 260 patients were studied. Discordance rate was 23.4% (n = 70, 10.7% iFR-negative discordant, 12.7% iFR-positive discordant). Predictors of discordance were LM/LAD disease, multivessel disease, non-ST-elevation myocardial infarction, smoking, reduced eGFR and hypertension. Lesion reclassification with tailored iFR cut-offs based on patient-level predictors carried no prognostic value among deferred lesions. Reclassification according to lesion location, which was entirely driven by LM/LAD lesions (iFR cut-offs: 0.93 for LM/LAD, 0.89 for non-LM/LAD), identified increased MACE among lesions deferred based on a negative FFR, between patients with a positive as compared with a negative iFR (19.4 vs. 6.1%, P = 0.044), whereas the same association was not observed with the conventional 0.89 iFR cut-off (15 vs. 8.6%, P = 0.303). CONCLUSION: Tailored vessel-based iFR cut-offs carry prognostic value among FFR-negative lesions, suggesting that a one-size-fit-all iFR cut-off might be clinically unsatisfactory.
KW - Aged
KW - Coronary Artery Disease
KW - Coronary Stenosis
KW - Female
KW - Fractional Flow Reserve, Myocardial
KW - Humans
KW - Male
KW - Myocardial Revascularization
KW - Prognosis
KW - Retrospective Studies
KW - Time-to-Treatment
KW - Aged
KW - Coronary Artery Disease
KW - Coronary Stenosis
KW - Female
KW - Fractional Flow Reserve, Myocardial
KW - Humans
KW - Male
KW - Myocardial Revascularization
KW - Prognosis
KW - Retrospective Studies
KW - Time-to-Treatment
UR - http://hdl.handle.net/10807/196950
U2 - 10.2459/JCM.0000000000001264
DO - 10.2459/JCM.0000000000001264
M3 - Article
SN - 1558-2027
VL - 23
SP - 106
EP - 115
JO - Journal of Cardiovascular Medicine
JF - Journal of Cardiovascular Medicine
ER -