The Influence of Lesion Location on the Diagnostic Accuracy of Adenosine-Free Coronary Pressure Wire Measurements

• Published in: JACC. Cardiovascular interventions 2016-12, Vol.9 (23), p.2390-2399
• Main Authors: Kobayashi, Yuhei, MD, Johnson, Nils P., MD, MS, Berry, Colin, MBChB, PhD, De Bruyne, Bernard, MD, PhD, Gould, K. Lance, MD, Jeremias, Allen, MD, MSc, Oldroyd, Keith G., MBChB, MD, Pijls, Nico H.J., MD, PhD, Fearon, William F., MD
• Format: Article
• Language: English
• Subjects: Adenosine - administration & dosage; Aged; Area Under Curve; Arterial Pressure; Cardiac Catheterization - instrumentation; Cardiac Catheterization - methods; Cardiac Catheters; Cardiovascular; contrast fractional flow reserve; Coronary Artery Disease - diagnosis; Coronary Artery Disease - physiopathology; Coronary Circulation; Coronary Vessels - physiopathology; Equipment Design; Europe; Female; fractional flow reserve; Humans; Hyperemia - physiopathology; instantaneous wave-free ratio; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; ROC Curve; Transducers, Pressure; United States; Vasodilator Agents - administration & dosage
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2016.08.041

Abstract Objectives This work compares the diagnostic performance of adenosine-free coronary pressure wire indices based on lesion location. Background Several adenosine-free coronary pressure wire indices have been proposed to assess the functional significance of coronary artery lesions; however, there is a theoretical concern that lesion location and the mass of perfused myocardium may affect diagnostic performance. Methods A total of 763 patients were prospectively enrolled from 12 institutions. Fractional flow reserve (FFR) and contrast-based FFR (cFFR) were obtained during adenosine-induced maximal hyperemia and contrast-induced submaximal hyperemia respectively, whereas the instantaneous wave-free ratio (iFR) and distal pressure/aortic pressure (Pd/Pa) were obtained at rest. Using an FFR of ≤0.80 as a reference standard, the diagnostic accuracy of each index was compared based on lesion location (left main or proximal left anterior descending artery [LM/pLAD] compared with other lesion locations). Results The median FFR, cFFR, iFR, and Pd/Pa were 0.81 (interquartile range: 0.74 to 0.87), 0.86 (0.79 to 0.91), 0.90 (0.85 to 0.94), and 0.92 (0.88 to 0.95), respectively. The cFFR, iFR, and Pd/Pa were less accurate in LM/pLAD compared with other lesion locations (cFFR: 80.3% vs. 87.8%; iFR: 73.3% vs. 81.8%; Pd/Pa: 71.4% vs. 81.1%, respectively). By receiver-operating characteristics curve analysis, cFFR provided better diagnostic accuracy than resting indices regardless of lesion location (p ≤ 0.0001 vs. iFR and Pd/Pa for both groups). Conclusions The cFFR, iFR, and Pd/Pa are less accurate in LM/pLAD compared with other lesion locations, likely related to the larger amount of myocardium supplied by LM/pLAD. Nevertheless, cFFR provides the best diagnostic accuracy among the adenosine-free indices, regardless of lesion location.