Angiography Versus Hemodynamics to Predict the Natural History of Coronary Stenoses

Ciccarelli, Giovanni; Barbato, Emanuele; Tóth, Gábor G.; Gahl, Brigitta; Xaplanteris, Panagiotis; Fournier, Stéphane; Milkas, Anastasios; Bartúnek, Jozef; Vanderheyden, Marc; Pijls, Nico H.J.; Tonino, Pim A.L.; Fearon, William F.; Jüni, Peter; Bruyne, Bernard De

doi:10.1161/circulationaha.117.028782

Cited by 72 publications

(26 citation statements)

References 34 publications

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“…The reproducibility of these assessments is good, and similar to that reported in previous QFR studies. 3. Findings of pathological QFR are not rare (7.7% of all vessels measured) and are more frequent in the LAD than in LCX and RCA.…”

Section: Discussionmentioning

confidence: 96%

“…Invasive methods to assess the hemodynamic significance of coronary artery stenoses are associated with improved short-and long-term outcomes, principally driven by a reduced incidence of revascularization and target vessel myocardial infarction [1][2][3]. Despite their advantages, the penetration of these invasive techniques remains low due to cost or logistic considerations, limited access, and a perceived increased risk associated with intracoronary procedures and the administration of vasodilators.…”

Section: Discussionmentioning

confidence: 99%

“…Several tools have been developed to overcome this limitation, among which fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) represent the most frequently adopted. Given their reliability in the prediction of cardiovascular events and consequently in guiding the decision whether to perform percutaneous coronary intervention (PCI) [1][2][3][4][5][6][7][8], the use of these methods is recommended as Class IA in the current guidelines on myocardial revascularization [9]. Despite the indisputable benefit of these functional indexes, their use increases the invasiveness and the cost of procedure, and their penetration remains unfortunately low.…”

Section: Introductionmentioning

confidence: 99%

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QFR Predicts the Incidence of Long-Term Adverse Events in Patients with Suspected CAD: Feasibility and Reproducibility of the Method

Buono¹,

Mühlenhaus²,

Schäfer³

et al. 2020

JCM

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AIMS: We evaluate feasibility and reproducibility of post hoc quantitative flow ratio (QFR) measurements and their prognostic predictive power during long-term follow-up. METHODS AND RESULTS: Between 2010 and 2012, 167 patients without angiographic evidence of significant stenoses were enrolled in a prospective registry. Of these patients, 96% presented 7 years follow-up data. QFR was measured post hoc by three certified investigators. QFR analysis was feasible in 71% of left anterior descending (LAD), 72% of left circumflex (LCX), and 61% of right (RCA) coronaries for a total of 350 measurements repeated in triplicate. Coefficients of variation were 2.1% for RCA and LCX, and 2.8% for the LAD (quartile coefficients of dispersion respectively 1.5, 1.4, and 1.3). QFR ≤0.80 was recorded in 25 patients (27 vessels, in 74% of the cases LAD). A total of 86 major adverse cardiovascular and cerebrovascular events were observed in 76 patients. QFR ≤0.80 in at least one of the three vessels was the strongest predictor of events (HR 3.14, 95%CI 1.78–5.54, p = 0.0001). This association was maintained in several sensitivity analyses. CONCLUSIONS: QFR reproducibility is acceptable, even when analysis is performed post hoc. A pathological QFR is not rare in patients without angiographic evidence of significant stenosis and is a predictor of incident events during long-term follow-up. Condensed Abstract: In a post hoc analysis of 167 patients without evidence of angiographic significant stenosis, the presence of QFR value ≤0.80 in at least one of the three coronary vessels showed to be the strongest predictor of major adverse cardiovascular and cerebrovascular events during long-term follow-up. QFR reproducibility have been shown to be acceptable among experienced operators.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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QFR Predicts the Incidence of Long-Term Adverse Events in Patients with Suspected CAD: Feasibility and Reproducibility of the Method

Buono¹,

Mühlenhaus²,

Schäfer³

et al. 2020

JCM

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“…Therefore, iFR-controlled stent implantation is recommended for stenoses with narrowing of the lumen at the range of 40-90% and the values of the iFR < 0.89, or FFR < 0.80. The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 2 (FAME2) study confirmed better efficacy of FFR (iFR) -guided PCI as compared to only optimal medical treatment (OMT) (hazard ratio (HR) 0.32 [95% confidence interval (CI) 0.19-0.53; p < 0.001]) [9][10][11]. In Ukraine, FFR/iFR-guided PCI is performed in the Institute of Car Adopted from Davies JE et al [14].…”

Section: Introductionmentioning

confidence: 98%

Multi-Vessel Coronary Artery Disease: Choice of Myocardial Revascularization Strategy

et al. 2020

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Multi-vessel coronary artery disease is quite a common state, which is often diagnosed by coronary angiography in patients with both stable coronary artery disease and acute coronary syndromes. Major difficulties in percutaneous coronary intervention include stent thrombosis and the need for antiplatelet therapy (aspirin and a P2Y12 inhibitor). Stent thrombosis leads to the recurrence of myocardial infarction and may occur within the first few hours after percutaneous coronary intervention. The use of dual antiplatelet therapy, especially that combined with low-molecular-weight heparin in the first days after myocardial infarction, poses a risk of bleeding, which often occurs in real clinical practice. Among P2Y12 inhibitors, ticagrelor causes bleeding somewhat more frequently than clopidogrel. A case of multi-vessel coronary artery disease is described in this paper. Coronary angiography revealed right-dominant circulation; occlusion of the proximal and medial segments of the right coronary artery, thrombolysis in myocardial infarction flow grade 0; stenosis of the left main coronary artery (50-60%), thrombolysis in myocardial infarction flow grade 2; diffuse stenosis of the medial and distal segments of the left anterior descending artery, thrombolysis in myocardial infarction flow grade 1; stenosis of the proximal segment of the left circumflex artery (> 75%), thrombolysis in myocardial infarction flow grade 1. The patient underwent percutaneous coronary intervention; the stents were implanted in the infarct-dependent right coronary artery. The clinical course was complicated by early stent thrombosis with subsequent thrombus extraction; a day later melena developed. Bleeding was stopped, the intensity of antithrombotic therapy was reduced: the combination of aspirin and ticagrelor was replaced by the combination of aspirin and clopidogrel. Six weeks after stenting of the infarct-dependent coronary artery, complete myocardial revascularization (hybrid intervention) was performed: coronary artery bypass grafting [the left internal mammary artery → the left anterior descending artery], coronary autogenous bypass grafting [the aorta → the right coronary artery and the aorta → the left circumflex artery]. The role of fractional flow reserve or instantaneous wave-free ratio-controlled complete myocardial revascularization techniques is discussed. The following algorithm for myocardial revascularization was used: percutaneous coronary intervention for the right coronary artery + coronary artery bypass grafting-3: the left internal mammary artery → the left anterior descending artery, the aorta → the left circumflex artery, the aorta → the right coronary artery.

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“…In a study published in 2007, 8 in 250 patients (452 lesions) assessed by FFR before PCI, 32% of the lesions had their initially planned treatment strategy modified after FFR measurement, which is a major change because it would imply inadequate treatment in more than one third of the patients. More recently, Ciccarelli et al 9 in a FAME 2 substudy, analyzed the value of angiography compared to FFR to predict the natural history of coronary lesions, correlating MCAE index with the angiographic and physiological importance of these lesions in patients (n = 607) who were initially left only on drug treatment. In the subgroups in which FFR was discordant of angiography (FFR > 0.80 and SD ≥ 50% or FFR ≤ 0.80 and SD < 50%), clinical progression was worse in those in whom FFR was ≤ 0, 80, even if the lesion was not significant, and benign in those in whom FFR was > 0.80, regardless of SD.…”

mentioning

confidence: 99%

Analysis of FFR Measurement Clinical Impact and Cost-Effectiveness Compared to Angiography In Multi-Arterial Patients Undergoing PCI

Sant’Anna

2018

Arquivos Brasileiros De Cardiologia

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Angiography Versus Hemodynamics to Predict the Natural History of Coronary Stenoses

Abstract: URL: https://clinicaltrials.gov. Unique identifier: NCT01132495.

Cited by 72 publications

References 34 publications

QFR Predicts the Incidence of Long-Term Adverse Events in Patients with Suspected CAD: Feasibility and Reproducibility of the Method

QFR Predicts the Incidence of Long-Term Adverse Events in Patients with Suspected CAD: Feasibility and Reproducibility of the Method

Multi-Vessel Coronary Artery Disease: Choice of Myocardial Revascularization Strategy

Analysis of FFR Measurement Clinical Impact and Cost-Effectiveness Compared to Angiography In Multi-Arterial Patients Undergoing PCI

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