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

Coronary interventions

Age and functional relevance of coronary stenosis: a post hoc analysis of the ADVISE II trial

EuroIntervention 2021;17:757-764. DOI: 10.4244/EIJ-D-20-01163

1. Interventional Cardiology Unit, Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain; 2. Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal; 3. Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 4. Amsterdam UMC, University of Amsterdam, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; 5. Hospital General ISSSTE Querétaro, Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro, México; 6. University Clinic of Cardiology, Faculty of Medicine at University of Lisbon, Lisbon, Portugal; 7. Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy; 8. Rivoli Infermi Hospital, Turin, Italy; 9. Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA; 10. Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom; 11. Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; 12. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; 13. Department of Cardiology, National University of Ireland, Galway, Ireland; 14. Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA

Background: The influence of age-dependent changes on fractional flow reserve (FFR) or instantaneous wave-free 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 a 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 explaining differences observed in functional stenosis classification with hyperaemic and non-hyperaemic coronary indices.

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