Author + information
- Tim van de Hoef1,
- Gilbert Wijntjens2,
- Martijn Meuwissen3,
- Mauro Echavarria Pinto4,
- Martijn van Lavieren5,
- Karel Koch6,
- Steven Chamuleau7,
- Michiel Voskuil8,
- Robert de Winter9,
- Jan Tijssen10 and
- Jan Piek11
- 1Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
- 2Academisch Medisch Centrum, Amsterdam, Netherlands
- 3Breda Amphia Ziekenhuis, Breda, Netherlands
- 4Hospital General ISSSTE, Queretaro, Querétaro, Mexico
- 5Academic Medical Center- University of Amster, Amsterdam, Netherlands
- 6Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
- 7UMCU, Utrecht, Netherlands
- 8UMC Utrecht
- 9Academisch Medisch Centrum, Amsterdam, Netherlands
- 10AMC-UVA, Naarden, Netherlands
- 11University of Amsterdam, Amsterdam, Netherlands
iFR and Pd/Pa are novel indices introduced to enhance adoption of physiology-guided revascularization. Their absolute agreement with FFR is 80%, but both indices agree better with coronary flow reserve (CFR) than FFR. Since CFR is a critical determinant of myocardial ischemia and clinical outcome, we hypothesized that this agreement with CFR results in dominant prognostic value of iFR and Pd/Pa over FFR.
Between 4-1997 and 9-2006, we studied 154 stenoses (154 patients), in which revascularization was deferred, with intracoronary pressure and flow measurements. Follow-up (median 11.8 years) was performed to study the occurrence of adverse events: a composite of cardiac death, myocardial infarction and target vessel revascularization (MACE).
CFR had dominant prognostic value (standardized HR:0.59 (95%CI: 0.43–0.80)), but the association of Pd/Pa with long-term MACE was similar to that of FFR (FFR sHR:0.77 (95%CI: 0.61–0.98); Pd/Pa sHR:0.80 (95%CI: 0.67–0.96)). iFR was available in 44 stenoses, and was also significantly associated with long-term MACE (iFR sHR:0.66 (95%CI: 0.46–0.95)). When Pd/Pa or iFR disagreed with FFR, normal Pd/Pa or iFR was generally associated with normal CFR values and had favorable clinical outcome, whereas abnormal Pd/Pa or iFR was generally associated with CFR values around the ischemic cut-off value and had impaired clinical outcome.
The prognostic value of Pd/Pa and iFR is at least equivalent to FFR. When Pd/Pa or iFR disagrees with FFR, the resting index dominantly determines long-term MACE, likely through better agreement with CFR.
IMAGING: FFR and Physiologic Lesion Assessment