Lesion characteristics of coronary arteries associated with a mismatch between angiographic severity of stenosis and fractional flow reserve

Cardiovasc Interv Ther. 2017 Apr;32(2):120-126. doi: 10.1007/s12928-016-0399-8. Epub 2016 May 28.

Abstract

We aimed to clarify the relationships between angiographic lesion characteristics and values of fractional flow reserve (FFR) on intermediate coronary artery stenosis. The clinical meaning and assessment for "visual-functional mismatches," including regular-mismatches [defined as angiographic percent diameter stenosis (%DS) ≥50 % and FFR >0.80] and reverse-mismatches (defined as angiographic %DS <50 %, FFR ≤0.80) remains unresolved in contemporary practice. We retrospectively enrolled 140 consecutive patients who underwent coronary angiography and FFR measurement. One hundred fifty-seven cases of intermediate coronary artery stenosis were evaluated. The relationship between clinical/lesion characteristics and regular- or reverse-mismatches were examined. Lesions in the left anterior descending artery (LAD) showed significantly lower frequency of regular-mismatch than did non-LAD lesions (26.7 vs. 73.3 %, respectively; p < 0.001). Conversely, almost all reverse-mismatches were observed in LAD lesions (93.8 %). The best cut-off value of %DS, derived from receiver operating characteristic (ROC) curve analysis, to predict FFR ≤0.8 was 45.0 % in LAD lesions and 67.5 % in non-LAD lesions. FFR measurement should be considered in LAD intermediate lesions to avoid residual functional ischemia and in non-LAD lesions to avoid unnecessary coronary intervention.

Keywords: Fractional flow reserve; Lesion characteristic; Percutaneous coronary intervention; Visual-functional mismatch.

MeSH terms

  • Aged
  • Cardiac Catheterization / methods*
  • Coronary Angiography / methods*
  • Coronary Stenosis / diagnosis*
  • Coronary Stenosis / physiopathology
  • Coronary Stenosis / surgery
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / physiopathology
  • Coronary Vessels / surgery
  • Female
  • Follow-Up Studies
  • Fractional Flow Reserve, Myocardial*
  • Humans
  • Male
  • Percutaneous Coronary Intervention
  • ROC Curve
  • Retrospective Studies
  • Severity of Illness Index