Prevalence of visual–functional mismatch regarding coronary artery stenosis in the CVIT-DEFER registry

Abstract

The fractional flow reserve (FFR) is considered to be a reliable index for the assessment of clinically relevant coronary artery stenosis. However, mismatch in assessing the severity of coronary stenosis between coronary angiography and the FFR has been pointed out. The cardiovascular intervention therapeutics (CVIT)-DEFER registry is a prospective multicenter registry study that has enrolled 3,228 consecutive patients among 3,804 patients with angiographically moderate coronary artery lesions in whom FFR analysis was clinically indicated. The demographic and angiographic parameters associated with an FFR ≤0.8 were analyzed, and the incidence of discrepancy between the angiographic severity of coronary stenosis and the FFR was assessed. Based on the visual assessment, 1,609 (42.9%) lesions were categorized as showing 50% stenosis, 1,882 lesions (50.2%) as 75% stenosis, and 257 lesions (6.9%) as 90% stenosis. Angiographic-FFR "mismatch," which was defined as visual stenosis ≥75% with FFR >0.80, was found in 43.4% of lesions, while reverse angiographic mismatch (visual stenosis <75% with FFR ≤0.8) was found in 23.2%. The independent predictors for "angiographic-FFR mismatch" were the presence of percutaneous coronary intervention (PCI) history, one-vessel disease, non-left anterior descending artery (LAD) location, non-diffuse lesion, non-ostial lesion, and non-tandem lesion. Conversely, "reverse angiographic mismatch" was independently associated with the multivessel disease, LAD location, and diffuse lesion. The FFR is not only influenced by luminal stenosis but also by coronary artery morphology and the amount of jeopardized myocardium. Angiographic-FFR mismatch is frequent in patients with moderate coronary stenosis, which suggests the clinical importance of using physiological assessment to guide PCI.

One-Year Outcome of Fractional Flow Reserve-Based Coronary Intervention in Japanese Daily Practice ― CVIT-DEFER Registry ―

“…Reverse mismatch findings, which indicate that FFR is significantly low even though the angiographic degree of stenosis is not so severe, are more frequent in the LAD. 7 Such visual information might have some influence on decision-making of PCI indication. Conventionally, revascularization strategy decision-making is based on the presence or absence of subjective symptoms, together with multimodal ischemic evaluation results; thus, we believe that the physicians did not necessarily select treatment solely on the basis of FFR result.…”

Integrated Myocardial Perfusion Imaging Diagnostics Improve Detection of Functionally Significant Coronary Artery Stenosis by 13 N-ammonia Positron Emission Tomography

“…2,13 In managing patients with suspected coronary artery disease, optimal thresholds of quantitative 11 or invasive coronary angiography 6,8,11 ), FFR, combination of both tests, 9,12,23 or relative PD combined with ST-segment depression and clinical history of angina. 10 It is well known that angiographic determinations of stenosis and related myocardial ischemia often diverge, 15,18,[33][34][35][36][37][38] so interpretation of previous study results must consider the methods used to define lesion-specific ischemia. Such discrepancies may even present in lesions beyond intermediate-range severity.…”

Clinical Outcomes of Deferred Lesions With Angiographically Insignificant Stenosis But Low Fractional Flow Reserve

“…It is well known that a discrepancy exists between angiographic stenosis severity and the presence of myocardial ischemia 2, 3, 4, 5, 6, 7, 8, 9, 10. This discrepancy cannot be completely resolved, even with more precise invasive imaging modalities, such as intravascular ultrasound or optical coherence tomography 11, 12, 13, 14.…”