The Influence of Lesion Location on the Diagnostic Accuracy of Adenosine-Free Coronary Pressure Wire Measurements. Academic Article uri icon

Overview

abstract

  • OBJECTIVES: This work compares the diagnostic performance of adenosine-free coronary pressure wire indices based on lesion location. BACKGROUND: Several adenosine-free coronary pressure wire indices have been proposed to assess the functional significance of coronary artery lesions; however, there is a theoretical concern that lesion location and the mass of perfused myocardium may affect diagnostic performance. METHODS: A total of 763 patients were prospectively enrolled from 12 institutions. Fractional flow reserve (FFR) and contrast-based FFR (cFFR) were obtained during adenosine-induced maximal hyperemia and contrast-induced submaximal hyperemia respectively, whereas the instantaneous wave-free ratio (iFR) and distal pressure/aortic pressure (Pd/Pa) were obtained at rest. Using an FFR of ≤0.80 as a reference standard, the diagnostic accuracy of each index was compared based on lesion location (left main or proximal left anterior descending artery [LM/pLAD] compared with other lesion locations). RESULTS: The median FFR, cFFR, iFR, and Pd/Pa were 0.81 (interquartile range [IQR]: 0.74 to 0.87), 0.86 (IQR: 0.79 to 0.91), 0.90 (IQR: 0.85 to 0.94), and 0.92 (IQR: 0.88 to 0.95), respectively. The cFFR, iFR, and Pd/Pa were less accurate in LM/pLAD compared with other lesion locations (cFFR: 80.3% vs. 87.8%; iFR: 73.3% vs. 81.8%; Pd/Pa: 71.4% vs. 81.1%, respectively). By receiver-operating characteristics curve analysis, cFFR provided better diagnostic accuracy than resting indices regardless of lesion location (p ≤0.0001 vs. iFR and Pd/Pa for both groups). CONCLUSIONS: The cFFR, iFR, and Pd/Pa are less accurate in LM/pLAD compared with other lesion locations, likely related to the larger amount of myocardium supplied by LM/pLAD. Nevertheless, cFFR provides the best diagnostic accuracy among the adenosine-free indices, regardless of lesion location.

authors

  • Kobayashi, Yuhei
  • Johnson, Nils P
  • Berry, Colin
  • De Bruyne, Bernard
  • Gould, K Lance
  • Jeremias, Allen
  • Oldroyd, Keith G
  • Pijls, Nico H J
  • Fearon, William F

publication date

  • November 9, 2016

Research

keywords

  • Adenosine
  • Arterial Pressure
  • Cardiac Catheterization
  • Cardiac Catheters
  • Coronary Artery Disease
  • Coronary Circulation
  • Coronary Vessels
  • Transducers, Pressure
  • Vasodilator Agents

Identity

Scopus Document Identifier

  • 85001115484

Digital Object Identifier (DOI)

  • 10.1016/j.jcin.2016.08.041

PubMed ID

  • 27838269

Additional Document Info

volume

  • 9

issue

  • 23