TY - JOUR

T1 - Diagnostic performance of angiography-based fractional flow reserve by patient and lesion characteristics

AU - Kobayashi, Yuhei

AU - Collet, Carlos

AU - Achenbach, Stephan

AU - Engstrøm, Thomas

AU - Assali, Abid

AU - Shlofmitz, Richard

AU - Fournier, Stephane

AU - Kirtane, Ajay J.

AU - Ali, Ziad A.

AU - Kornowski, Ran

AU - Leon, Martin B.

AU - De Bruyne, Bernard

AU - Fearon, William F.

AU - Jeremias, Allen

AU - Greenberg, Gabriel

AU - Jubeh, Rami

AU - Kolansky, Daniel M.

AU - McAndrew, Thomas

AU - Dressler, Ovidiu

AU - Matsumura, Mitsuaki

AU - Maehara, Akiko

AU - for the FAST-FFR study investigators

N1 - Funding Information: The FAST-FFR trial was funded by CathWorks. Publisher Copyright: © Europa Digital & Publishing 2021. All rights reserved.

PY - 2021/7

Y1 - 2021/7

N2 - Background: A large, prospective, multicentre trial recently showed that fractional flow reserve (FFR) derived from coronary angiography (FFRangio) has an accuracy of 92% compared with conventional guidewire-based FFR (FFRwire); however, little is known about whether specific patient/lesion characteristics affect the diagnostic performance. Aims: The primary goal of the present study was to investigate whether specific patient or lesion characteristics such as high body mass index (BMI), presentation with an acute coronary syndrome, or lesion location affect the diagnostic performance of FFRangio in patients enrolled in the FAST-FFR study. Methods: FFRangio was measured in a blinded fashion in 301 patients (319 vessels) who were undergoing FFRwire assessment. Using an FFRwire ≤0.80 as a reference, the diagnostic performance of FFRangio was compared in pre-specified subgroups. Results: The mean FFRwire and FFRangio were 0.81±0.13 and 0.80±0.12. Overall, FFRangio had a sensitivity of 93.5% and specificity of 91.2% for predicting FFRwire. Patient characteristics including age, sex, clinical presentation, body mass index, and diabetes did not affect sensitivity or specificity (p>0.05 for all). Similarly, lesion characteristics including calcification and tortuosity did not affect sensitivity or specificity (p>0.05 for all), nor did lesion location (proximal, middle, versus distal). Sensitivity was equally high across all target vessels, while specificity was highest in the LAD and lower (~85%) in the RCA and LCx (p<0.05). Conclusions: FFRangio derived from coronary angiography has a high diagnostic performance regardless of patient and most lesion characteristics. The interaction of vessel on the specificity will need to be confirmed in larger cohorts.

AB - Background: A large, prospective, multicentre trial recently showed that fractional flow reserve (FFR) derived from coronary angiography (FFRangio) has an accuracy of 92% compared with conventional guidewire-based FFR (FFRwire); however, little is known about whether specific patient/lesion characteristics affect the diagnostic performance. Aims: The primary goal of the present study was to investigate whether specific patient or lesion characteristics such as high body mass index (BMI), presentation with an acute coronary syndrome, or lesion location affect the diagnostic performance of FFRangio in patients enrolled in the FAST-FFR study. Methods: FFRangio was measured in a blinded fashion in 301 patients (319 vessels) who were undergoing FFRwire assessment. Using an FFRwire ≤0.80 as a reference, the diagnostic performance of FFRangio was compared in pre-specified subgroups. Results: The mean FFRwire and FFRangio were 0.81±0.13 and 0.80±0.12. Overall, FFRangio had a sensitivity of 93.5% and specificity of 91.2% for predicting FFRwire. Patient characteristics including age, sex, clinical presentation, body mass index, and diabetes did not affect sensitivity or specificity (p>0.05 for all). Similarly, lesion characteristics including calcification and tortuosity did not affect sensitivity or specificity (p>0.05 for all), nor did lesion location (proximal, middle, versus distal). Sensitivity was equally high across all target vessels, while specificity was highest in the LAD and lower (~85%) in the RCA and LCx (p<0.05). Conclusions: FFRangio derived from coronary angiography has a high diagnostic performance regardless of patient and most lesion characteristics. The interaction of vessel on the specificity will need to be confirmed in larger cohorts.

KW - Fractional flow reserve

KW - QCA

KW - Stable angina

U2 - 10.4244/EIJ-D-19-00933

DO - 10.4244/EIJ-D-19-00933

M3 - Journal article

C2 - 32364503

AN - SCOPUS:85111526665

VL - 17

SP - E294-E300

JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

IS - 4

ER -