TY - JOUR
T1 - Clinical usefulness of nonhyperemic baseline Pd/Pa as a hybrid baseline Pd/Pafractional flow reserve strategy
AU - Kwon, Taek Geun
AU - Matsuzawa, Yasushi
AU - Li, Jing
AU - Aoki, Tatsuo
AU - Guddeti, Raviteja R.
AU - Widmer, R. Jay
AU - Cilluffo, Rebecca R.
AU - Lennon, Ryan J.
AU - Lerman, Lilach O.
AU - Lerman, Amir
N1 - Publisher Copyright:
© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
PY - 2015/1/14
Y1 - 2015/1/14
N2 - Objective The ratio of basal distal intracoronary pressure (Pd) and aortic pressure (Pa) is a nonhyperemic index for the severity of coronary artery stenosis. The aim of the current study was to evaluate the clinical usefulness of a hybrid baseline Pd/Pafractional flow reserve (FFR) strategy in reducing the need for hyperemia.Methods In this study, 570 lesions from 527 consecutive patients who had both baseline Pd/Pa and FFR determined were evaluated retrospectively. To evaluate the hybrid baseline Pd/PaFFR approach, patients were categorized into treatment, deferral, and undetermined groups on the basis of their baseline Pd/Pa. Thereafter, patients in the undetermined group were assigned to FFR-guided treatment or deferral on the basis of an FFR cutoff value of 0.80 or lower. Major adverse cardiac events were evaluated in a median of 48.8 months (interquartile range, 35.066.4).Results A hybrid strategy using a deferral baseline Pd/Pa value of 1.00 (negative predictive value of 100%) and a treatment baseline Pd/Pa value of 0.86 or lower (positive predictive value of 100%), and limiting adenosine to a baseline Pd/Pa value between 0.87 and 0.99 would prevent the need for vasodilator drugs in 14.6% of lesions (14.0% patients), maintaining 100% agreement with an FFR-only strategy. However, adenosine-free lesions are increased to 59.6%, with 91% agreement. There was no difference in the major adverse cardiac event-free survival rate at 5 years between baseline Pd/Pa-guided and FFR-guided treatment patients (70.8 vs. 76.3%, P=0.63), or between baseline Pd/ Pa-guided and FFR-guided deferral patients (71.3 vs. 82.4%, P=0.99).Conclusion The current study reports a range of baseline Pd/Pa values that can predict myocardial ischemia without the need for inducing hyperemia. Adoption of this hybrid baseline Pd/PaFFR approach can reduce the need for drug-induced hyperemia.
AB - Objective The ratio of basal distal intracoronary pressure (Pd) and aortic pressure (Pa) is a nonhyperemic index for the severity of coronary artery stenosis. The aim of the current study was to evaluate the clinical usefulness of a hybrid baseline Pd/Pafractional flow reserve (FFR) strategy in reducing the need for hyperemia.Methods In this study, 570 lesions from 527 consecutive patients who had both baseline Pd/Pa and FFR determined were evaluated retrospectively. To evaluate the hybrid baseline Pd/PaFFR approach, patients were categorized into treatment, deferral, and undetermined groups on the basis of their baseline Pd/Pa. Thereafter, patients in the undetermined group were assigned to FFR-guided treatment or deferral on the basis of an FFR cutoff value of 0.80 or lower. Major adverse cardiac events were evaluated in a median of 48.8 months (interquartile range, 35.066.4).Results A hybrid strategy using a deferral baseline Pd/Pa value of 1.00 (negative predictive value of 100%) and a treatment baseline Pd/Pa value of 0.86 or lower (positive predictive value of 100%), and limiting adenosine to a baseline Pd/Pa value between 0.87 and 0.99 would prevent the need for vasodilator drugs in 14.6% of lesions (14.0% patients), maintaining 100% agreement with an FFR-only strategy. However, adenosine-free lesions are increased to 59.6%, with 91% agreement. There was no difference in the major adverse cardiac event-free survival rate at 5 years between baseline Pd/Pa-guided and FFR-guided treatment patients (70.8 vs. 76.3%, P=0.63), or between baseline Pd/ Pa-guided and FFR-guided deferral patients (71.3 vs. 82.4%, P=0.99).Conclusion The current study reports a range of baseline Pd/Pa values that can predict myocardial ischemia without the need for inducing hyperemia. Adoption of this hybrid baseline Pd/PaFFR approach can reduce the need for drug-induced hyperemia.
KW - adenosine
KW - fractional flow reserve
KW - hyperemia
KW - survival
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U2 - 10.1097/MCA.0000000000000174
DO - 10.1097/MCA.0000000000000174
M3 - Article
C2 - 25279565
AN - SCOPUS:84988293944
SN - 0954-6928
VL - 26
SP - 49
EP - 54
JO - Coronary Artery Disease
JF - Coronary Artery Disease
IS - 1
ER -