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Optical Coherence Tomography-Guided Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction: A Prospective Propensity-Matched Cohort of the Thrombectomy Versus Percutaneous Coronary Intervention Alone Trial Impact of an optical coherence tomography guided approach in acute coronary syndromes: A propensity matched analysis from the international FORMIDABLE-CARDIOGROUP IV and USZ registry Optical coherence tomography and C-reactive protein in risk stratification of acute coronary syndromes Intravascular optical coherence tomography Levosimendan Improves Hemodynamics and Exercise Tolerance in PH-HFpEF: Results of the Randomized Placebo-Controlled HELP Trial Validation of bifurcation DEFINITION criteria and comparison of stenting strategies in true left main bifurcation lesions Immunotherapy of Endothelin-1 Receptor Type A for Pulmonary Arterial Hypertension Chronic thromboembolic pulmonary hypertension Lesion-Specific and Vessel-Related Determinants of Fractional Flow Reserve Beyond Coronary Artery Stenosis Relationship Between Coronary Artery Calcium and Atherosclerosis Progression Among Patients With Suspected Coronary Artery Disease

Original Research2017 Dec;30(6):564-569.

JOURNAL:J Interv Cardiol. Article Link

Diagnostic accuracy of instantaneous wave free-ratio in clinical practice

Ding WY, Nair S, Appleby C. Keywords: fractional flow reserve; functional testing; instantaneous wave-free ratio; pressure wire studies

ABSTRACT


AIMS - To evaluate the correlation between iFR and FFR in real-world clinical practice.


METHODS AND RESULTS - Retrospective, single-centre study of 229 consecutive pressure-wire studies (np  = 158). Real-time iFR and FFR measurements were performed for angiographically borderline stenoses. Functionally significant stenoses were defined as iFR <0.86 or FFR ≤0.80. An iFR between 0.86 and 0.93 was considered within the grey zone (Hybrid approach). Median iFR and FFR (IQR) were 0.92 (0.87-0.95) and 0.83 (0.76-0.89), respectively. Pearson's correlation coefficient was 0.75 (P < 0.001). Bland-Altman plot showed a mean difference between iFR and FFR that remained consistent throughout the range of values. The optimal iFR cutoff was 0.91-sensitivity 80%, specificity 82% with ROC area under curve of 89%. Using the Hybrid iFR-FFR strategy, we demonstrated high accuracy of iFR results-sensitivity 95%, specificity 96%, PPV 95%, and NPV 96%. In addition, this method would have avoided adenosine in 56% of patients. Mean follow-up period was 17.2 (±3.4) months. All-cause mortality was 3.2% (np = 5) and repeat intervention was required in six lesions (2.6%).


CONCLUSIONS - This study demonstrates that iFR is a valuable adjunct to FFR using the Hybrid iFR-FFR strategy in a real-world population. The use of adenosine may be avoided in about half the cases.


© 2017, Wiley Periodicals, Inc.