Original Research

DOI: 10.4244/EIJ-D-23-00713

Impact of hyperaemic stenosis resistance on long-term outcomes of stable angina in the ILIAS Registry

Coen K.M. Boerhout1, MD; Mauro Echavarría-Pinto2, MD, PhD; Guus A. de Waard3, MD, PhD; Joo Myung Lee4, MD, PhD; Hernán Mejía-Rentería5, MD, PhD; Seung Hun Lee6, MD, PhD; Ji-Hyun Jung7, MD; Masahiro Hoshino8, MD; Hitoshi Matsuo8, MD, PhD; Maribel Madera-Cambero9, MD; Ashkan Eftekhari10, MD, PhD; Mohamed A. Effat11, MD; Tadashi Murai12, MD; Koen Marques1, MD, PhD; Joon-Hyung Doh13, MD, PhD; Evald H. Christiansen14, MD, PhD; Rupak Banerjee15, PhD; Chang-Wook Nam16, MD, PhD; Giampaolo Niccoli17, MD, PhD; Masafumi Nakayama18,19, MD, PhD; Nobuhiro Tanaka20, MD, PhD; Eun-Seok Shin21, MD, PhD; Marcel A.M. Beijk1, MD, PhD; Niels van Royen3, MD, PhD; Paul Knaapen1, MD, PhD; Javier Escaned5, MD, PhD; Tsunekzu Kakuta12, MD, PhD; Bon-Kwon Koo22, MD, PhD; Jan J. Piek1, MD, PhD; Tim P. van de Hoef1,23, MD, PhD; Martijn Meuwissen24, MD, PhD

Abstract

BACKGROUND: The hyperaemic stenosis resistance (HSR) index was introduced to provide a more comprehensive indicator of the haemodynamic severity of a coronary lesion. HSR combines both the pressure drop across a lesion and the flow through it. As such, HSR overcomes the limitations of the more traditional fractional flow reserve (FFR) or coronary flow reserve (CFR) indices.

AIMS: We aimed to identify the diagnostic and prognostic value of HSR and evaluate the clinical implications.

METHODS: Patients with chronic coronary syndromes (CCS) and obstructive coronary artery disease were selected from the multicentre ILIAS Registry. For this study, only patients with combined Doppler flow and pressure measurements were included.

RESULTS: A total of 853 patients with 1,107 vessels were included. HSR more accurately identified the presence of inducible ischaemia compared to FFR and CFR (area under the curve 0.71 vs 0.66 and 0.62, respectively; p<0.005 for both). An abnormal HSR measurement was an independent and important predictor of target vessel failure at 5-year follow-up (hazard ratio 3.80, 95% confidence interval: 2.12-6.73; p<0.005). In vessels deferred from revascularisation, HSR seems to identify more accurately those vessels that may benefit from revascularisation rather than FFR and/or CFR.

CONCLUSIONS: The present study affirms the theoretical advantages of the HSR index for the detection of ischaemia-Âinducing coronary lesions in a large CCS population. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry], ClinicalTrials.gov: NCT04485234)

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Volume 20 Number 11
Jun 3, 2024
Volume 20 Number 11
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