Clinical Relevance of Functionally Insignificant Moderate Coronary Artery Stenosis Assessed by 3‐Vessel Fractional Flow Reserve Measurement

Abstract

BackgroundUnderstanding of the risk conferred by functionally insignificant lesions in multiple coronary vessels is limited. We investigated the prognostic implications of coronary artery disease (CAD) based on 3‐vessel fractional flow reserve (FFR).Methods and ResultsA total of 1,136 patients underwent FFR measurement in the 3 major epicardial arteries. We defined vessels with “Moderate CAD” as vessels with FFR, 0.81 to 0.87. Patients were classified into Group 1: No apparent CAD (FFR>0.87 in all 3‐vessels); Group 2: Single‐vessel moderate CAD; Group 3: Multivessel moderate CAD; and Group 4: Functionally significant CAD (FFR≤0.80) in any vessel. The primary end point was 2‐year major adverse cardiac events, a composite of cardiac death, myocardial infarction, and ischemia‐driven revascularization. Forty‐three percent of patients had moderate CAD (Group 2: 403/1136, 35.5%; Group 3: 84/1136, 7.4%). The 2‐year risk of major adverse cardiac events was not significantly different between patients with single‐vessel moderate CAD and no apparent CAD (2.6 versus 2.6%; HR, 1.1; 95% confidence interval, 0.4%–2.8%; P=0.89). However, patients with multivessel moderate CAD were at significantly higher risk than Group 1 (7.4 versus 2.6%; hazard ratio, 3.3; 95% confidence interval, 1.1%–9.8%; P=0.03). The risk of major adverse cardiac events in patients with multivessel moderate CAD was comparable to that of patients with functionally significant CAD (hazard ratio, 1.2; 95% confidence interval, 0.5%–3.0%; P=0.67). In a multivariable regression model, multivessel moderate CAD was an independent predictor of greater risk of 2‐year major adverse cardiac events.ConclusionsGlobal physiologic assessment with FFR measurement of 3 vessels can identify multivessel moderate CAD. The prognostic implication of multivessel moderate CAD appears comparable to that of functionally significant CAD.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01621438.

Safety and Long-Term Clinical Outcomes of Fractional Flow Reserve Guided Coronary Revascularisation

“…The lesion location, lesion characteristics and multiple vessel involvement have also been shown to affect the likelihood of TVR in deferred lesions [15]. Park et al (2018) [19] demonstrated that patients with an FFR of 0.81-0.87 in all three vessel territories have a similar risk of TVR as patients with any one lesion ,0.80. It has also been shown that left main coronary artery and right coronary artery lesions are independent predictors of need for TVR in deferred lesions [20].…”

Numerical analysis of the pressure drop across highly-eccentric coronary stenoses: application to the calculation of the fractional flow reserve

“…In order to illustrate the potential clinical relevance of the segmentation error, we have correlated our results with a statistical analysis recently published from direct FFR measurements in more than 3000 vessels [ 45 ]. The idea is to imagine that the FFR values presented in the histogram in Fig.…”

“…1 of Ref. [ 45 ] (the dark grey curve in Fig. 18 ) were calculated from CFD simulations with the right geometry instead of experimentally.…”

“…1 of Ref. [ 45 ] (dark grey), and the one modified following the procedure described in the text (light grey) …”

Predictive value of the QFR in detecting vulnerable plaques in non-flow limiting lesions: a combined analysis of the PROSPECT and IBIS-4 study

“…Fractional flow reserve (FFR) is the gold standard for assessing the physiologic significance of a coronary artery lesion and planning treatment. This modality, which also appears able to provide useful prognostic information even in non-flow limiting lesions [1], involves advancement of a pressure wire across the lesion and adenosine administration to achieve hyperaemia and thus it comes with additional procedure-related risks of adverse events, extended procedure time and increased cost [2]. Quantitative flow ratio (QFR), a wire-free, hyperaemia-free method has been recently introduced to overcome these limitations and derive FFR from models reconstructed from 3-dimensional quantitative coronary angiography (3D-QCA) [3].…”