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Overestimates fractional flow reserve severity of LAD lesions?

Session Poster session 1

Speaker Shu Yokota

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : S Yokota (Zwolle,NL), NM Borren (Zwolle,NL), JP Ottervanger (Zwolle,NL), M Mouden (Zwolle,NL), JR Timmer (Zwolle,NL), S Knollema (Zwolle,NL), PL Jager (Zwolle,NL)

S. Yokota1 , N.M. Borren1 , J.P. Ottervanger1 , M. Mouden1 , J.R. Timmer1 , S. Knollema1 , P.L. Jager1 , 1Isala Hospital - Zwolle - Netherlands ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 202

Background: Fractional flow reserve (FFR) is increasingly used to estimate the severity of coronary stenoses, prior to coronary revascularization. However, it has been suggested that FFR overestimates the severity of left anterior descending (LAD) lesions.

Purpose: Our aim was to verify whether in patients without ischemia on myocardial perfusion imaging, FFR of the LAD is more often abnormal in comparison to FFR of other coronary arteries.

Methods: Between 2010 and 2014 within 6 months after normal myocardial perfusion imaging, 133 patients underwent invasive angiography and FFR measurement because of persistent or worsening of angina complaints. FFR measurements in a graft or diagonal branch were excluded. In these patients, 167 FFR measurements were performed, of which 85 in the LAD. A FFR ≤0.80 denoted a significant stenosis.

Results: Mean age of the patients was 64.8±10.5 years, 40% were women. There were no differences in baseline characteristics between patients undergoing LAD and non-LAD measurements. An abnormal FFR was observed in 35.3% of the LAD measurements, compared to 9.8% in the non-LAD measurements (p=0.001). Also after adjusting for age and gender, the FFR remained more frequently abnormal in the LAD with OR 5.2 (95% CI 2.2–12.3). Of the abnormal FFR LAD measurements, 70% had no angiographic severe stenosis.

Conclusions: In selected patients without ischemia on MPI, FFR measurement of the LAD is significantly more often abnormal, the majority of these patients has no significant lesions on invasive angiography. Possibly, FFR overestimates severity of LAD lesions, with risk of unnecessary revascularization.

Abnormal angiographic and FFR findings in 167 coronary arteries
VesselNumber (%)Angiographic significant (%)FFR <0.80 (%)
Total number16735 (21)38 (22.8)
LM8 (4.8)4 (50)2 (25)
LAD85 (51)14 (16.5)30 (35)
RCX35 (21)9 (25.7)1 (2.9)
AL5 (3)0 (0)0 (0)
RCA34 (20.4)8 (23.5)5 (14.7)

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