The influence of lesion location on the diagnostic accuracy of adenosine-free coronary pressure wire measurements

Kobayashi, Y., Johnson, N. P., Berry, C. , De Bruyne, B., Gould, K. L., Jeremias, A., Oldroyd, K. G., Pijls, N. H.J. and Fearon, W. F. (2016) The influence of lesion location on the diagnostic accuracy of adenosine-free coronary pressure wire measurements. JACC: Cardiovascular Interventions, 9(23), pp. 2390-2399. (doi: 10.1016/j.jcin.2016.08.041) (PMID:27838269)

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 [IQR]: 0.74 to 0.87), 0.86 (IQR: 0.79 to 0.91), 0.90 (IQR: 0.85 to 0.94), and 0.92 (IQR: 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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Berry, Professor Colin and Oldroyd, Dr Keith
• Authors: Kobayashi, Y., Johnson, N. P., Berry, C., De Bruyne, B., Gould, K. L., Jeremias, A., Oldroyd, K. G., Pijls, N. H.J., and Fearon, W. F.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: JACC: Cardiovascular Interventions
• Publisher: Elsevier
• ISSN: 1936-8798
• ISSN (Online): 1876-7605
• Published Online: 09 November 2016