Impact of instantaneous wave-free ratio on graft failure after coronary artery bypass graft surgery. (1st February 2021)

• Record Type: Journal Article
• Authors: Wada, Teruaki; Shiono, Yasutsugu; Kubo, Takashi; Honda, Kentaro; Takahata, Masahiro; Shimamura, Kunihiro; Yuzaki, Mitsuru; Tanimoto, Takashi; Matsuo, Yoshiki; Tanaka, Atsushi; Hozumi, Takeshi; Nishimura, Yoshiharu; Akasaka, Takashi
• Is Part Of: International journal of cardiology. Volume 324(2021)
• Page Start: 23
• Page End: 29
• Publication Date: 2021-02-01
• Subjects: Instantaneous wave-free ratio -- Coronary artery bypass grafting -- And coronary artery disease; CABG coronary artery bypass grafting -- CFR coronary flow reserve -- CT computed tomography -- DS diameter stenosis -- FFR fractional flow reserve -- iFR instantaneous wave free ratio -- LAD left anterior descending coronary artery -- PCI percutaneous coronary intervention -- QCA quantitative coronary angiography -- IMA internal mammary artery -- RA radial artery; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.09.046
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: We aimed to assess an impact of instantaneous wave-free ratio (iFR) on a graft failure after coronary artery bypass grafting (CABG). Methods and results: A total of 131 coronary arteries from 88 patients who underwent invasive coronary angiography, intracoronary pressure measurements, CABG, and scheduled follow-up coronary computed tomography angiography within one year were investigated. All studied arteries had FFR <0.80. The rate of graft failure was significantly higher in vessels with negative iFR (>0.89) than in those with positive iFR (<0.89) (25.7% vs. 7.3%, p = 0.012). The graft failure rates increased as the preoperative iFR values rose (iFR <0.80, 3.3%; iFR: 0.80–0.84, 5.6%; iFR: 0.85–0.89, 16.0%; iFR: 0.90–0.94, 28.0%; and iFR: 0.95–1.00, 50.0%; p = 0.002). A cut-off value of iFR to predict graft failures was determined as 0.84 by receiver-operating characteristic curve analysis with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 88%, 62%, 25%, 97%, and 66%, respectively. Conclusions: The risk of graft failure becomes higher, as the preoperative iFR increases. The graft failure is significantly more frequent when a bypass graft is anastomosed on vessels with negative iFR than those with positive iFR. Highlights: No study to date has determined whether preoperative iFR is associated with graft patency after CABG. The rate of graft failure is significantly higher when anastomosed on vessels with negative iFR than those with positive iFR. The higher the preoperative iFR is, the more risk of graft failure within 1 year after CABG.