Clinical Outcome of Lesions With Discordant Results Among Different Invasive Physiologic Indices ― Resting Distal Coronary to Aortic Pressure Ratio, Resting Full-Cycle Ratio, Diastolic Pressure Ratio, Instantaneous Wave-Free Ratio, and Fractional Flow Reserve ―

• DOI: 10.1253/circj.cj-19-0230
• Publication Date: 2019-09-03T22:04:26Z
• Authors: Joo Myung Lee; Tae-Min Rhee; Ki Hong Choi; Jonghanne Park; Doyeon Hwang; Jinseob Kim; Jinhyoung Park; Hyung Yoon Kim; Hae Won Jung; Yun-Kyeong Cho; Hyuck-Jun Yoon; Young Bin Song; Joo-Yong Hahn; Chang-Wook Nam; Eun-Seok Shin; Joon-Hyung Doh; Seung-Ho Hur; Bon-Kwon Koo
• Keywords: Male; Cardiac Catheterization; Time Factors; Coronary Stenosis; Hyperemia; Coronary Artery Disease; Coronary Angiography; Prognosis; Coronary Vessels; Fractional Flow Reserve, Myocardial; 03 medical and health sciences; 0302 clinical medicine; Diastole; Predictive Value of Tests; Republic of Korea; Humans; Arterial Pressure; Female; Registries

We evaluated the 2-year clinical outcomes of deferred lesions with discordant results between resting and hyperemic pressure-derived physiologic indices, including resting distal to aortic coronary pressure (resting Pd/Pa), instantaneous wave-free ratio (iFR), resting full-cycle ratio (RFR), diastolic pressure ratio (dPR), and fractional flow reserve (FFR).Methods and Results:The 2-year clinical outcomes of 1,024 vessels (435 patients) with available resting Pd/Pa, iFR, RFR, dPR, and FFR data were analyzed according to a 4-group classification using known cutoff values (resting Pd/Pa ≤0.92, iFR/RFR/dPR ≤0.89, and FFR ≤0.80): Group 1 (concordant normal), Group 2 (high resting index and low FFR), Group 3 (low resting index and high FFR), and Group 4 (concordance abnormal). The primary outcome was vessel-oriented composite outcomes (VOCO) in deferred vessels at 2 years. In the comparison of VOCO risk among 4 groups classified according to FFR and 4 resting physiologic indices, Group 4 consistently showed a significantly higher risk of VOCO than Group 1. Comparison of VOCO risk among 4 groups classified according to iFR and other resting physiologic indices also showed the same results. The presence of discordance, either between hyperemic and resting indices or among resting indices, was not an independent predictor for VOCO.Discordant results between resting physiologic indices and FFR and among the resting indices were not associated with increased risk of VOCO in deferred lesions.