Author + information
- Gilbert Wijntjens1,
- Martijn van Lavieren2,
- Tim van de Hoef3,
- Mauro Echavarria Pinto4,
- Martijn Meuwissen5,
- Valérie Stegehuis6,
- Karel Koch3,
- Steven Chamuleau7,
- Michiel Voskuil8,
- Robbert de Winter3,
- Jan Tijssen9,
- Javier Escaned10 and
- Jan Piek11
- 1Academisch Medisch Centrum, Amsterdam, Netherlands
- 2Academic Medical Center- University of Amster, Amsterdam, Netherlands
- 3Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
- 4Hospital General ISSSTE, Queretaro, Querétaro, Mexico
- 5Breda Amphia Ziekenhuis, Breda, Netherlands
- 6Academic Medical Center, Amsterdam, Netherlands
- 7UMCU, Utrecht, Netherlands
- 8University Medical Center Utrecht, Utrecht, Netherlands
- 9AMC, Naarden, Netherlands
- 10Hospital Clínico San Carlos, Madrid, Spain
- 11Academic Medical Center, University of Amsterdam, Amsterdam, Netherland
Pressure-bounded coronary flow reserve (Pb-CFR) is a novel technique that estimates the bounds of CFR from routine pressure measurements, but has not been compared with flow-derived CFR (CFR) regarding clinical outcome. We compared the long-term prognostic value of Pb-CFR versus CFR.
We evaluated 453 intermediate coronary lesions with intracoronary pressure and flow sensors (298 lesions by Doppler flow velocity and 155 lesions by the thermodilution method). The lower and higher bound of Pb-CFR were defined as √[(1-FFR)/(1-Pd/Pa)] and (1-FFR)/(1-Pd/Pa), respectively. Long-term follow-up (median: 11.8 years) was performed in 153 lesions deferred from treatment to document the occurrence of major adverse cardiac events (MACE) defined as a composite of cardiac death, myocardial infarction and target vessel revascularization.
The bounds of Pb-CFR were conclusive <2.0 or ≥2.0 in 259 out of 453 vessels (57%). Of these, Pb-CFR was <2.0 in 161 out of 259 (62%) and CFR was <2.0 in 124 out of 259 vessels (48%). Pb-CFR agreed with CFR in 188 out of 259 vessels (73%)(Cohen’s kappa 0.46, p<0.01). Pb-CFR was conclusive <2.0 or ≥2.0 in 85 out of 153 vessels (56%) analysed for long-term MACE, of which Pb-CFR was <2.0 in 35 out of 85 (41%) and CFR was <2.0 in 17 out of 85 vessels (20%). No difference in 10-year MACE was shown for vessels with Pb-CFR <2.0 versus ≥2.0 (Breslow p=0.194, fig 1A), whereas vessels with an CFR<2.0 were associated with increased MACE rates over time (Breslow p<0.001, fig 1B).
Pb-CFR does not match CFR as a risk stratification tool at their contemporary cut-off value.
IMAGING: FFR and Physiologic Lesion Assessment