The prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention

Abstract

Abnormal FFR or abnormal CFR was documented in 31% of intermediate coronary lesions. Deferral of PCI in this group was associated with a high MACE rate, which underscores the rationale of combined pressure and flow measurements providing a stenosis resistance index that is better suited for clinical decision making in these lesions.

Disturbed Coronary Hemodynamics in Vessels With Intermediate Stenoses Evaluated With Fractional Flow Reserve

“…This approach provides a richer perspective of coronary hemodynamics and might help to identify patients who, despite a normal FFR, have impaired myocardial blood supply and, potentially, poorer prognosis ( Figure 3). 23 Both CFR and FFR were originally used to assess functional stenotic significance; however, beyond the close concordance initially reported, 24 a significant disagreement between both methods has been consistently found, like in our study. 23,25,26 Recently, a new interpretation of the classification agreement between FFR and CFR was proposed by Johnson et al 8 on the grounds of published studies and original findings with CFR derived from non-invasive positron emission tomography (PET; Figure 1A).…”

“…23 Both CFR and FFR were originally used to assess functional stenotic significance; however, beyond the close concordance initially reported, 24 a significant disagreement between both methods has been consistently found, like in our study. 23,25,26 Recently, a new interpretation of the classification agreement between FFR and CFR was proposed by Johnson et al 8 on the grounds of published studies and original findings with CFR derived from non-invasive positron emission tomography (PET; Figure 1A). A fluid dynamic model fitting their observations suggests that the distribution of values in the four quadrants of the FFR/ CFR relationship obeys to the relative contributions of focal stenosis, DAN, and MCD.…”

“…In this regard, for example, other authors have reported a worse prognosis in patients with D group vessels. Among 159 patients with FFR≥0.75, Meuwissen et al 23 found that those (n=28) with abnormal Doppler-derived CFR presented a significantly higher MACE rate (17%) at 1-year follow-up than those (n=129) with normal CFR (5% MACE rate). Similar conclusions come from noninvasive studies.…”

Paradigm Shift to Functional Angioplasty

“…32 Among the 513 lesions in patients in whom treatment was deferred on the basis of FFR value, only 1 (0.2%) experienced an myocardial infarction and only 16 (3.2%) required repeat revascularizations. Other studies [33][34][35][36][37][38] have consistently shown that the rates of death and myocardial infarction in patients with deferred treatment of lesions are quite low (Table 1). In most of those studies, however, patient populations were small and follow-up periods were relatively short.…”

“…Pijls et al 32 Oud et al 33 Legalery et al 34 Mates et al 35 Reczuch et al 36 Meuwissen et al 37 39 Briguori et al 40 Takagi et al 41 Abizaid et al 42 Jasti et al 43 Lee et al 44 Kang et al 45 Functional other important factors also affect coronary flow, including the degree of diameter stenosis, lesion length, plaque burden, vessel size, lesion morphology, plaque characteristics, blood viscosity, collateral circulation, and subtended myocardial perfusion bed. 15 Some of these factors can be measured as simply as MLA, but others cannot.…”