Comparison of adenosine‐independent pressure indices to fractional flow reserve in stent‐jailed bifurcation side branches. Issue 3 (20th June 2022)

• Record Type: Journal Article
• Authors: Altstidl, Johannes Michael; Achenbach, Stephan; Marwan, Mohamed; Tröbs, Monique; Schacher, Nora; Ferstl, Paul; Gerlach, Andreas; Schlundt, Christian; Gaede, Luise
• Is Part Of: Catheterization and cardiovascular interventions. Volume 100:Issue 3(2022)
• Page Start: 369
• Page End: 377
• Publication Date: 2022-06-20
• Subjects: catheterization diagnostic -- coronary artery disease -- fractional flow reserve; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.30298
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives and Background: This study aims to evaluate whether the high correlation and classification agreement of the instantaneous wave‐free ratio (iFR) and the resting distal coronary to aortic pressure ratio ( P d /P a ) with the fractional flow reserve (FFR) can be confirmed in stent‐jailed side branches (J‐SB). Methods: Consecutive patients ( n = 49) undergoing provisional stenting were prospectively enrolled and a physiological assessment of the J‐SB ( n = 51) was performed. FFR, iFR, and P d / P a were measured and the hemodynamic relevance was determined using cutoff values of ≤0.80, ≤0.89, and ≤0.92, respectively. Results: Both iFR ( r = 0.75) and P d / P a ( r = 0.77) correlated closely with FFR. Classification agreement with FFR was 78% for iFR (81% sensitivity, 77% specificity) and 75% for P d / P a (63% sensitivity and 80% specificity). However, angiographic diameter stenosis and pressure indices correlated poorly. For a threshold of ≥70% stenosis, agreement concerning hemodynamic relevance was found in 59% for FFR, 69% for iFR, and 61% for P d / P a . Conclusion: As reported for other lesion types, FFR and the adenosine‐independent pressure indices iFR and P d / P a show close correlation and a high classification agreement of approximately 75%–80% in J‐SB. Therefore, iFR can be regarded as a recommendable alternative to FFR for the guidance of provisional stenting in bifurcation lesions.