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

Coronary interventions - Mini focus on coronary physiology

Diagnostic performance of angiography-based fractional flow reserve by patient and lesion characteristics

EuroIntervention 2021;17:e294-e300. DOI: 10.4244/EIJ-D-19-00933

1. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; 2. Department of Cardiology, Cardiovascular Center Aalst OLV Hospital, Aalst, Belgium; 3. Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany; 4. The Heart Center, Rigs Hospital, University of Copenhagen, Copenhagen, Denmark; 5. Department of Cardiology, Meir Medical Center, Kfar Saba, Israel; 6. Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA; 7. Columbia University Medical Center, New York, NY and Cardiovascular Research Foundation, New York, NY, USA; 8. Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; 9. Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA

Background: A large, prospective, multicentre trial recently showed that fractional flow reserve (FFR) derived from coronary angiography (FFRangio) has an accuracy of 92% compared with conventional guidewire-based FFR (FFRwire); however, little is known about whether specific patient/lesion characteristics affect the diagnostic performance.

Aims: The primary goal of the present study was to investigate whether specific patient or lesion characteristics such as high body mass index (BMI), presentation with an acute coronary syndrome, or lesion location affect the diagnostic performance of FFRangio in patients enrolled in the FAST-FFR study.

Methods: FFRangio was measured in a blinded fashion in 301 patients (319 vessels) who were undergoing FFRwire assessment. Using an FFRwire ≤0.80 as a reference, the diagnostic performance of FFRangio was compared in pre-specified subgroups.

Results: The mean FFRwire and FFRangio were 0.81±0.13 and 0.80±0.12. Overall, FFRangio had a sensitivity of 93.5% and specificity of 91.2% for predicting FFRwire. Patient characteristics including age, sex, clinical presentation, body mass index, and diabetes did not affect sensitivity or specificity (p>0.05 for all). Similarly, lesion characteristics including calcification and tortuosity did not affect sensitivity or specificity (p>0.05 for all), nor did lesion location (proximal, middle, versus distal). Sensitivity was equally high across all target vessels, while specificity was highest in the LAD and lower (~85%) in the RCA and LCx (p<0.05).

Conclusions: FFRangio derived from coronary angiography has a high diagnostic performance regardless of patient and most lesion characteristics. The interaction of vessel on the specificity will need to be confirmed in larger cohorts.

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