Author + information
- Saroj Neupane1,
- Sushruth Edla2,
- Raid Saco3,
- Anwar Zaitoun4,
- James Torrey3,
- Susan Szpunar3 and
- Antonious Attalah3
- 1St. John Hospital and Medical Center, Madison Heights, Michigan, United States
- 2St John Hospital and Medical Center, Saint Clair Shores, Michigan, United States
- 3St John Hospital and Medical Center, Detroit, Michigan, United States
- 4St. John Hospital and Medical Center, Harper Woods, Michigan, United States
The influence of the amount of myocardium at risk subtended by a coronary stenosis in hemodynamic significance of a coronary stenosis is unclear. The aim of our study was to evaluate the influence of the amount of myocardium subtended by a coronary stenosis on hemodynamic significance of the stenosis as determined by fractional flow reserve (FFR).
We retrospectively evaluated consecutive patients (pts) with stable coronary artery disease who underwent coronary angiography and FFR. The % severity and qualitative lesion length (QLL) of a stenosis were determined by visual estimation. Coronary stenosis was defined as functionally significant if FFR was ≤0.8. Myocardium at risk subtended by coronary stenosis was estimated by using BCIS-1 Myocardial Jeopardy Score.
Total number of patients who underwent FFR in study period was 314. 274 (Age 65.27± 11.29, 53% male, 1 artery per patient) patients were included in the analysis; 88 (32%) had positive FFR. The % severity of stenosis was significantly higher in positive FFR group (71.65 vs. 61.48%, p<0.001) compared to negative FFR group. Postive FFR group also had significantly higher number of diffuse lesions (20.5 vs. 3.2 %, p<0.0001). BCIS-1 score was similar between the vessels with positive FFR compared to the vessels with negtaive FFR (3.93 ± 1.78 vs. 3.50 ±1.76, p=0.061).There was no correlation between FFR value and BCIS score (r=-0.07, p=0.231).
|Angiographic Characteristics||Negative FFR (n=186)||Positive FFR (n=88)||p-value|
|Angina||126 (65.3)||68 (76.4)||0.172|
|Abnormal Stress Test||34 (17.6)||11 (12.4)||0.172|
|Other||33 (17.1)||9 (11.2)||0.172|
|Radial||147 (79.0)||65 (73.9)||0.337|
|Femoral||39 (21.0)||23 (26.1)||0.337|
|LAD||98 (52.7)||66 (75.0)||0.008|
|RCA||57 (30.6)||17 (19.3)||0.008|
|LCx||14 (7.5)||3 (3.4)||0.008|
|Other||17 (9.1)||2 (2.2)||-|
|Qualitative Lesion length|
|Focal||132 (71.0)||45 (51.1)||<0.0001|
|Tubular||48 (25.9)||25 (28.4)||<0.0001|
|Diffuse||6 (3.2)||18 (20.5)||<0.0001|
|Significant Stenosis in other arteries||43 (23.1)||23 (26.1)||0.715|
|BCIS-1 Myocardial Jeopardy Score||3.50||3.93||0.061|
The Myocardium at risk subtended by a coronary stenosis is not associated with a higher probability that a coronary stenosis is functionally significant and a poor predictor of hemodynamic significance of the coronary stenosis.
IMAGING: FFR and Physiologic Lesion Assessment