Clinical usefulness of nonhyperemic baseline Pd/Pa as a hybrid baseline Pd/Pafractional flow reserve strategy

Taek Geun Kwon, Yasushi Matsuzawa, Jing Li, Tatsuo Aoki, Raviteja R. Guddeti, R. Jay Widmer, Rebecca R. Cilluffo, Ryan J. Lennon, Lilach O. Lerman, Amir Lerman

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)49-54
Number of pages6
JournalCoronary Artery Disease
Volume26
Issue number1
DOIs
StatePublished - Jan 14 2015

Keywords

  • adenosine
  • fractional flow reserve
  • hyperemia
  • survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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