Abstract 19113: Fractional Flow Reserve versus Angiography to Assess Progression of Atherosclerosis
Fractional flow reserve (FFR) is superior to quantitative coronary angiography (QCA) in assessing coronary stenosis severity. Whether FFR can also be used to evaluate atherosclerosis progression has yet to be demonstrated.
Aim: To compare QCA and FFR in the assessment of atherosclerosis progression in patients (pts) undergoing two consecutive coronary angiograms.
Methods: In 147 coronary segments of 127 pts, QCA and FFR were measured in the same segment at baseline (BL) and at follow-up (FU) within a time interval ≥1year. Pts underwent repeat catheterization because of change in pattern of their symptoms. Exclusion factors: baseline FFR≤0.75, percutaneous treatment of study vessel. Minimal lumen diameter (MLD), % diameter stenosis (%DS) and reference diameter (RD) were measured by QCA to assess angiographic stenosis severity.
Results: At follow-up, angiographic stenosis severity significantly increased (MLD: from 1.73±0.42 to 1.66±0.44 mm, p<0.01; %DS: from 49±10 to 51±10, p<0.01). This was paralleled by a significant FFR decrease (from 0.86±0.06 to 0.84±0.08, p<0.01). No significant correlation was found between FFR changes and changes in MLD or %DS (r=0.07, p=0.39 and r=−0.10, p=0.24, respectively). At follow-up, 21 lesions crossed the ischemic FFR threshold of 0.75 (from 0.83±0.04 to 0.68±0.06, p<0.01), while only 4 of these lesions crossed the “ischemic” MLD threshold of 1.20 mm (from 1.22±0.14 to 0.99±0.18 mm, p=0.08). Interestingly, 13 lesions crossed the MLD threshold (from 1.25±0.20 to 1.08±0.08 mm, p=0.01) in spite of preserved FFR (FFR > 0.75) at the follow-up. The agreement between FFR and MLD evaluation of atherosclerosis progression was poor (K=0.095 [−0.19;0.384]).
Conclusions: No correlation between angiographic and functional estimation of atherosclerosis progression was observed. QCA leads to an erroneous decision-making in up to 20% of the lesions assessed at the occasion of follow-up angiography, warranting FFR measurement even in the absence of significant angiographic progression.
- © 2010 by American Heart Association, Inc.