The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Age and Functional Relevance of Coronary Stenosis: a Post-Hoc Analysis of the ADVISE II Trial

DOI: 10.4244/EIJ-D-20-01163

1.Interventional Cardiology Unit, Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid,  Spain; Cardiology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal;
2. Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
3. Amsterdam UMC, University of Amsterdam, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
4. Interventional Cardiology Unit, Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
5. Interventional Cardiology Unit, Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain. Hospital General ISSSTE Querétaro, Facultad de Medicina, Universidad Autónoma de Querétaro, México
6. Cardiology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal. University Clinic of Cardiology - Faculty of Medicine at University of Lisbon
7. Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy. Rivoli Infermi Hospital, Turin, Italy
8. Interventional Cardiology, Medstar Washington Hospital Center, Washington, USA
9. Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
10. Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
11. Department of Medicine, Emory University School of Medicine, Atlanta, USA
12. Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
13. Interventional Cardiology Unit, Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid,  Spain
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Background: The influence of age-dependent changes on fractional flow reserve (FFR) or instantaneous free-wave ratio (iFR) and the response to pharmacological hyperaemia has not been investigated.

 

Aims: We investigated the impact of age on these indices.

 

Methods: This is as post-hoc analysis of the ADVISE II trial, including a total of 690 pressure recordings (in 591 patients). Age-dependent correlations with FFR and iFR were calculated and adjusted for stenosis severity. Patients were stratified into three age terciles. The hyperaemic response to adenosine, calculated as the difference between resting and hyperaemic pressure ratios, and the prevalence of FFR-iFR discordance were assessed.

 

Results: Age correlated positively with FFR (r=0.08, 95% CI: 0.01 to 0.15, p=0.015), but not with iFR (r=-0.03, 95% CI: -0.11 to 0.04, p=0.411). The hyperaemic response to adenosine decreased with patient age (0.12 ± 0.07,  0.11 ± 0.06, 0.09 ± 0.05, for the 1st[33-58 years], 2nd[59-69 years] and 3rd[70-94 years] age tertiles, respectively, p<0.001) and showed significant correlation with age (r=-0.14, 95% CI -0.21 to -0.06, p<0.001). The proportion of patients with FFR≤0.80 + iFR>0.89 discordance doubled in the first age-tercile (14.1% vs 7.1% vs 7.0%, p=0.005).

 

Conclusions: The hyperaemic response of the microcirculation to adenosine administration is age-dependent. FFR values increase with patient age, while iFR values remain constant across the age spectrum. These findings contribute to explain differences observed in functional stenosis classification with hyperaemic and non-hyperaemic coronary indices.

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