Author + information
- Nina van der Hoeven1,
- Gladys Janssens2,
- Guus de Waard1,
- Henk Everaars2,
- Casper Beijnink2,
- Robin Nijveldt3,
- Christopher Cook4,
- Justin Davies4 and
- Niels van Royen5
Primary percutaneous intervention (pPCI) of non-culprit vessels in ST-segment elevation myocardial infarction (STEMI) patients is associated with improved clinical outcome. Fractional flow reserve (FFR) can guide revascularization of these non-culprit lesions. Recently instantaneous wave free ratio (iFR) was introduced as an adenosine-free alternative to FFR in patients with stable coronary artery disease and non-STEMI. In the acute setting of STEMI, coronary hemodynamics are altered, potentially influencing both FFR and iFR. The objective of the present study was to investigate the reliability of FFR and iFR to assess stenosis severity in non-culprit lesions in STEMI patients at the index event.
We included 43 STEMI patients with an additional non-culprit coronary lesion. Following successful pPCI, resting and hyperaemic intracoronary pressure measurements were performed. These measurements were repeated at 1-month follow-up. FFR and iFR were calculated for both time-points.
FFR significantly decreased (0.89±0.07 versus 0.87±0.08, p=0.003) and iFR significantly increased between baseline and follow-up (0.94±0.07 versus 0.95±0.05, p=0.025). Bland-Altman analysis showed a bias of 0.024 (FFR) and -0.021 (iFR). There was a significant correlation between FFR and iFR at baseline (ρ = 0.612) and during follow-up (ρ = 0.666)(p<0.001 for both). Discordance between baseline and follow-up was 23.3% in FFR compared to 11.6% in iFR, using established cut-off values (p=0.125).
In patients with STEMI, FFR values are slightly higher in the acute setting as compared to follow-up, whereas iFR values are slightly lower. This could potentially influence decisions regarding revascularization at the index event as compared to follow-up. Discordance between baseline and follow-up values were found in both FFR and iFR.
IMAGING: FFR and Physiologic Lesion Assessment