Author + information
- Yumiko Kanei,
- Bora Toklu,
- Neil Patel,
- Wonkyoung Lee and
- John Fox
Background: The instantaneous wave-free ratio (iFR) is a novel coronary artery pressure index measured in the wave-free period of diastole in absence of hyperemia. A modest correlation between iFR and fractional flow reserve (FFR) has been shown, and a hybrid iFR-FFR strategy has been reported to improve this correlation. The purpose of this study is to evaluate the predictors of positive FFR in coronary lesions with intermediate iFR values.
Methods: We reviewed 831 intermediate coronary lesions requiring functional evaluation using iFR in 720 patients referred for coronary angiography between January 2015 and February 2016. A hybrid protocol utilizing FFR only in lesions with intermediate iFR values between 0.86 to 0.93 was the standard approach. Additional FFR measurement and revascularization was performed at the discretion of the operator. Clinical and angiographic variables were assessed for their correlation with positive FFR (FFR<0.80).
Results: Among 831 intermediate coronary lesions, 86 lesions (10%) had positive iFR (<0.85), 296 lesions (36%) had intermediate iFR (0.86–0.93), and 449 lesions (54%) had negative iFR (>0.94). FFR was measured in 360 coronary lesions in 349 patients, including 68 lesions with negative iFR>0.94 values. Of those 360 lesions, 83 lesions had positive FFR, and 277 lesions had negative FFR. Patients with positive FFR were younger (62+12 vs 67 +10, p=0.0002), predominantly male (75% vs 56%, p=0.0031), had lower iFR values (0.89 +0.03 vs 0.94 + 0.04, p=0.0001), and had a trend to have history of PCI (43% vs 33%, p=0.08) and LAD lesions (92% vs 80%, p=0.071). The presence of diabetes mellitus and the presentation with acute coronary syndrome were not associated with positive FFR. Multiple regression analysis revealed, younger age, male gender, and iFR<0.90 were independent predictors of positive FFR.
Conclusions: In this single center, real world retrospective study, hybrid iFR-FFR approach reduced the use of adenosine by 57%. Younger age, male gender, and iFR<0.90 were independent predictors of positive FFR in coronary lesions with intermediate iFR.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Interventional Cardiology: Intravascular Physiology and Endothelial Function
Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology
Presentation Number: 1115-181
- 2017 American College of Cardiology Foundation