Lesion characteristics of coronary arteries associated with a mismatch between angiographic severity of stenosis and fra
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ORIGINAL ARTICLE
Lesion characteristics of coronary arteries associated with a mismatch between angiographic severity of stenosis and fractional flow reserve Hiroyuki Arashi1 • Junichi Yamaguchi1 • Mayui Nakazawa1 • Hisao Otsuki1 • Shintaro Haruki1 • Masashi Nakao1 • Kazuho Kamishima1 • Kentaro Jujo1 • Yuichiro Minami1 • Atsushi Takagi2 • Hiroshi Ogawa1 • Nobuhisa Hagiwara1
Received: 27 November 2015 / Accepted: 3 May 2016 Japanese Association of Cardiovascular Intervention and Therapeutics 2016
Abstract We aimed to clarify the relationships between angiographic lesion characteristics and values of fractional flow reserve (FFR) on intermediate coronary artery stenosis. The clinical meaning and assessment for ‘‘visualfunctional mismatches,’’ including regular-mismatches [defined as angiographic percent diameter stenosis (%DS) C50 % and FFR [0.80] and reverse-mismatches (defined as angiographic %DS \50 %, FFR B0.80) remains unresolved in contemporary practice. We retrospectively enrolled 140 consecutive patients who underwent coronary angiography and FFR measurement. One hundred fifty-seven cases of intermediate coronary artery stenosis were evaluated. The relationship between clinical/ lesion characteristics and regular- or reverse-mismatches were examined. Lesions in the left anterior descending artery (LAD) showed significantly lower frequency of regular-mismatch than did non-LAD lesions (26.7 vs. 73.3 %, respectively; p \ 0.001). Conversely, almost all reverse-mismatches were observed in LAD lesions (93.8 %). The best cut-off value of %DS, derived from receiver operating characteristic (ROC) curve analysis, to predict FFR B0.8 was 45.0 % in LAD lesions and 67.5 % in non-LAD lesions. FFR measurement should be considered in LAD intermediate lesions to avoid residual functional ischemia and in non-LAD lesions to avoid unnecessary coronary intervention.
& Junichi Yamaguchi [email protected] 1
Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
2
Department of Cardiology, Saiseikai Kawaguchi General Hospital, Saitama, Japan
Keywords Fractional flow reserve Lesion characteristic Percutaneous coronary intervention Visual-functional mismatch
Introduction Several studies have revealed that reducing myocardial ischemia with percutaneous coronary intervention (PCI) improves patients’ functional status and clinical outcomes [1, 2]. Fractional flow reserve (FFR) is a valuable index of myocardial functional ischemia [3]. Recently, PCI with FFR guidance was shown to be associated with significantly fewer clinical adverse events than PCI with angiographic guidance [4–7]. Moreover, the use of FFR can decrease procedural time and medical costs when it is used during PCI, rather than at the time of the diagnostic procedure [8]. FFR examination is currently recommended by clinical practice guidelines as a surrogate for the detection of myocardial ischemia in intermediate coronary artery stenosis [9]. Although FFR is a us
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