Diagnostic accuracy of a hybrid approach of instantaneous wave‐free ratio and fractional flow reserve using high‐dose intracoronary adenosine to characterize intermediate coronary lesions: Results of the PALS (Practical Assessment of Lesion Severity) prospective study

Objectives We sought to investigate the diagnostic accuracy of instantaneous wave‐free ratio (iFR) and high‐dose intracoronary adenosine fractional flow reserve (IC‐FFR) compared with classical intravenous adenosine fractional flow reserve (IV‐FFR) to assess coronary stenosis severity. The usefulnes...

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Published in:Catheterization and cardiovascular interventions 2017-12, Vol.90 (7), p.1070-1076
Main Authors: Rivero, Fernando, Cuesta, Javier, Bastante, Teresa, Benedicto, Amparo, García‐Guimaraes, Marcos, Fuentes‐Ferrer, Manuel, Alvarado, Teresa, Alfonso, Fernando
Format: Article
Language:English
Subjects:
Accuracy
Adenosine
catheterization
coronary artery disease
diagnostic
fractional flow reserve
Intravenous administration
Lesions
Stenosis
Stents
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container_title Catheterization and cardiovascular interventions
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creator Rivero, Fernando
Cuesta, Javier
Bastante, Teresa
Benedicto, Amparo
García‐Guimaraes, Marcos
Fuentes‐Ferrer, Manuel
Alvarado, Teresa
Alfonso, Fernando
description Objectives We sought to investigate the diagnostic accuracy of instantaneous wave‐free ratio (iFR) and high‐dose intracoronary adenosine fractional flow reserve (IC‐FFR) compared with classical intravenous adenosine fractional flow reserve (IV‐FFR) to assess coronary stenosis severity. The usefulness of two hybrid strategies combining iFR and high‐dose IC‐FFR was also evaluated. Background: Physiological assessment of intermediate coronary stenoses to guide revascularization is currently recommended. Methods: Consecutive real‐world patients with angiographically intermediate coronary stenosis (40–80% diameter stenosis) were prospectively included in the PALS (Practical Assessment of Lesion Severity) study. In every target lesion iFR, high‐dose IC‐FFR and IV‐FFR were systematically measured to assess the accuracy of an hybrid sequential approach combining iFR and IC‐FFR. Results: A total of 106 patients with 121 intermediate coronary lesions were analyzed. Both, iFR and IC‐FFR showed a significant correlation with IV‐FFR (iFR: r = 0.60, 95%CI 0.48–0.70; IC‐FFR: r = 0.88; 95%CI: 0.83–0.92). High‐dose IC‐FFR provided lower FFR values than IV‐FFR (0.81 ± 0.08 vs. 0.82 ± 0.09, P = 0.25). Using a receiver‐operating‐characteristic curve an optimal iFR threshold of 0.91 for the screening test was identified. A sequential test strategy (initial iFR followed by IC‐FFR only in lesions with iFR
doi_str_mv 10.1002/ccd.27038
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The usefulness of two hybrid strategies combining iFR and high‐dose IC‐FFR was also evaluated. Background: Physiological assessment of intermediate coronary stenoses to guide revascularization is currently recommended. Methods: Consecutive real‐world patients with angiographically intermediate coronary stenosis (40–80% diameter stenosis) were prospectively included in the PALS (Practical Assessment of Lesion Severity) study. In every target lesion iFR, high‐dose IC‐FFR and IV‐FFR were systematically measured to assess the accuracy of an hybrid sequential approach combining iFR and IC‐FFR. Results: A total of 106 patients with 121 intermediate coronary lesions were analyzed. Both, iFR and IC‐FFR showed a significant correlation with IV‐FFR (iFR: r = 0.60, 95%CI 0.48–0.70; IC‐FFR: r = 0.88; 95%CI: 0.83–0.92). High‐dose IC‐FFR provided lower FFR values than IV‐FFR (0.81 ± 0.08 vs. 0.82 ± 0.09, P = 0.25). Using a receiver‐operating‐characteristic curve an optimal iFR threshold of 0.91 for the screening test was identified. A sequential test strategy (initial iFR followed by IC‐FFR only in lesions with iFR &lt;0.91) yielded an excellent diagnostic accuracy (96.7%, 95%CI 96.7–99.1%) with a sensitivity, specificity, positive and negative predicted values of 100%, 94.7%, 91.8%, and 100%, respectively. A hybrid approach using the previously described iFR gray zone (0.85–0.94) also provided an excellent diagnostic accuracy (95%, 95%CI: 89.5–98.1%). 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The usefulness of two hybrid strategies combining iFR and high‐dose IC‐FFR was also evaluated. Background: Physiological assessment of intermediate coronary stenoses to guide revascularization is currently recommended. Methods: Consecutive real‐world patients with angiographically intermediate coronary stenosis (40–80% diameter stenosis) were prospectively included in the PALS (Practical Assessment of Lesion Severity) study. In every target lesion iFR, high‐dose IC‐FFR and IV‐FFR were systematically measured to assess the accuracy of an hybrid sequential approach combining iFR and IC‐FFR. Results: A total of 106 patients with 121 intermediate coronary lesions were analyzed. Both, iFR and IC‐FFR showed a significant correlation with IV‐FFR (iFR: r = 0.60, 95%CI 0.48–0.70; IC‐FFR: r = 0.88; 95%CI: 0.83–0.92). High‐dose IC‐FFR provided lower FFR values than IV‐FFR (0.81 ± 0.08 vs. 0.82 ± 0.09, P = 0.25). Using a receiver‐operating‐characteristic curve an optimal iFR threshold of 0.91 for the screening test was identified. A sequential test strategy (initial iFR followed by IC‐FFR only in lesions with iFR &lt;0.91) yielded an excellent diagnostic accuracy (96.7%, 95%CI 96.7–99.1%) with a sensitivity, specificity, positive and negative predicted values of 100%, 94.7%, 91.8%, and 100%, respectively. A hybrid approach using the previously described iFR gray zone (0.85–0.94) also provided an excellent diagnostic accuracy (95%, 95%CI: 89.5–98.1%). 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Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rivero, Fernando</au><au>Cuesta, Javier</au><au>Bastante, Teresa</au><au>Benedicto, Amparo</au><au>García‐Guimaraes, Marcos</au><au>Fuentes‐Ferrer, Manuel</au><au>Alvarado, Teresa</au><au>Alfonso, Fernando</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic accuracy of a hybrid approach of instantaneous wave‐free ratio and fractional flow reserve using high‐dose intracoronary adenosine to characterize intermediate coronary lesions: Results of the PALS (Practical Assessment of Lesion Severity) prospective study</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2017-12-01</date><risdate>2017</risdate><volume>90</volume><issue>7</issue><spage>1070</spage><epage>1076</epage><pages>1070-1076</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><abstract>Objectives We sought to investigate the diagnostic accuracy of instantaneous wave‐free ratio (iFR) and high‐dose intracoronary adenosine fractional flow reserve (IC‐FFR) compared with classical intravenous adenosine fractional flow reserve (IV‐FFR) to assess coronary stenosis severity. The usefulness of two hybrid strategies combining iFR and high‐dose IC‐FFR was also evaluated. Background: Physiological assessment of intermediate coronary stenoses to guide revascularization is currently recommended. Methods: Consecutive real‐world patients with angiographically intermediate coronary stenosis (40–80% diameter stenosis) were prospectively included in the PALS (Practical Assessment of Lesion Severity) study. In every target lesion iFR, high‐dose IC‐FFR and IV‐FFR were systematically measured to assess the accuracy of an hybrid sequential approach combining iFR and IC‐FFR. Results: A total of 106 patients with 121 intermediate coronary lesions were analyzed. Both, iFR and IC‐FFR showed a significant correlation with IV‐FFR (iFR: r = 0.60, 95%CI 0.48–0.70; IC‐FFR: r = 0.88; 95%CI: 0.83–0.92). High‐dose IC‐FFR provided lower FFR values than IV‐FFR (0.81 ± 0.08 vs. 0.82 ± 0.09, P = 0.25). Using a receiver‐operating‐characteristic curve an optimal iFR threshold of 0.91 for the screening test was identified. A sequential test strategy (initial iFR followed by IC‐FFR only in lesions with iFR &lt;0.91) yielded an excellent diagnostic accuracy (96.7%, 95%CI 96.7–99.1%) with a sensitivity, specificity, positive and negative predicted values of 100%, 94.7%, 91.8%, and 100%, respectively. A hybrid approach using the previously described iFR gray zone (0.85–0.94) also provided an excellent diagnostic accuracy (95%, 95%CI: 89.5–98.1%). Conclusions: In patients with intermediate coronary lesions a hybrid strategy by using a sequential approach of iFR and high‐dose IC‐FFR, provided a very good diagnostic performance to identify physiologically significant stenoses. © 2017 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28544741</pmid><doi>10.1002/ccd.27038</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-3676-0277</orcidid></addata></record>
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source Wiley-Blackwell Read & Publish Collection
subjects Accuracy
Adenosine
catheterization
coronary artery disease
diagnostic
fractional flow reserve
Intravenous administration
Lesions
Stenosis
Stents
title Diagnostic accuracy of a hybrid approach of instantaneous wave‐free ratio and fractional flow reserve using high‐dose intracoronary adenosine to characterize intermediate coronary lesions: Results of the PALS (Practical Assessment of Lesion Severity) prospective study
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