Agreement of the resting distal to aortic coronary pressure with the instantaneous wave-free ratio

Kobayashi, Y. et al. (2017) Agreement of the resting distal to aortic coronary pressure with the instantaneous wave-free ratio. Journal of the American College of Cardiology, 70(17), pp. 2105-2113. (doi:10.1016/j.jacc.2017.08.049) (PMID:29050557)

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Abstract

Background: Recently, 2 randomized controlled trials showed that the instantaneous wave-free ratio (iFR), a resting coronary physiological index, is noninferior to fractional flow reserve for guiding revascularization. The resting distal to aortic coronary pressure (Pd/Pa) measured at rest is another adenosine-free index widely available in the cardiac catheterization laboratory; however, little is known about the agreement of Pd/Pa using iFR as a reference standard. Objectives: The goal of this study was to investigate the agreement of Pd/Pa with iFR. Methods: A total of 763 patients were prospectively enrolled from 12 institutions. iFR and Pd/Pa were measured under resting conditions. Using iFR ≤0.89 as a reference standard, the agreement of Pd/Pa and its best cutoff value were assessed. Results: According to the independent core laboratory analysis, iFR and Pd/Pa were analyzable in 627 and 733 patients (82.2% vs. 96.1%; p < 0.001), respectively. The median iFR and Pd/Pa were 0.90 (interquartile range: 0.85 to 0.94) and 0.92 (interquartile range: 0.88 to 0.95), and the 2 indices were highly correlated (R2 = 0.93; p < 0.001; iFR = 1.31 * Pd/Pa –0.31). According to the receiver-operating characteristic curve analysis, Pd/Pa showed excellent agreement (area under the curve: 0.98; 95% confidence interval: 0.97 to 0.99; p < 0.001) with a best cutoff value of Pd/Pa ≤0.91. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 93.0%, 91.4%, 94.4%, 93.3%, and 92.7%, respectively. These results were similar in patients with acute coronary syndrome and stable angina. Conclusions: Pd/Pa was analyzable in a significantly higher number of patients than iFR. Pd/Pa showed excellent agreement with iFR, suggesting that it could be applied clinically in a similar fashion. (Can Contrast Injection Better Approximate FFR Compared to Pure Resting Physiology? [CONTRAST]; NCT02184117).

Item Type:Articles
Keywords:Fractional flow reserve, instantaneous wave-free ratio, resting distal to aortic coronary pressure.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin
Authors: Kobayashi, Y., Johnson, N. P., Zimmermann, F. M., Witt, N., Berry, C., Jeremias, A., Koo, B.-K., Esposito, G., Rioufol, G., Park, S.-J., Nishi, T., Choi, D.-H., Oldroyd, K. G., Barbato, E., Pijls, N. H. J., De Bruyne, B., and Fearon, W. F.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Journal of the American College of Cardiology
Publisher:Elsevier
ISSN:0735-1097
ISSN (Online):1558-3597
Published Online:16 October 2017
Copyright Holders:Copyright © 2017 American College of Cardiology Foundation
First Published:First published in Journal of the American College of Cardiology 70(17): 2105-2113
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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