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Coronary physiological assessment combining fractional flow reserve and index of microcirculatory resistance in patients undergoing elective percutaneous coronary intervention with grey zone fractional flow reserve
Author(s) -
Niida Takayuki,
Murai Tadashi,
Yonetsu Taishi,
Kanaji Yoshihisa,
Usui Eisuke,
Matsuda Junji,
Hoshino Masahiro,
Araki Makoto,
Yamaguchi Masao,
Hada Masahiro,
Ichijyo Sadamitsu,
Hamaya Rikuta,
Kanno Yoshinori,
Isobe Mitsuaki,
Kakuta Tsunekazu
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27570
Subject(s) - fractional flow reserve , medicine , conventional pci , percutaneous coronary intervention , cardiology , coronary flow reserve , revascularization , angina , coronary circulation , coronary artery disease , blood flow , coronary angiography , myocardial infarction
Objectives The aim of this study is to investigate the association between fractional flow reserve (FFR) values and change in coronary physiological indices after elective percutaneous coronary intervention (PCI). Background Decision making for revascularization when FFR is 0.75–0.80 is controversial. Methods A retrospective analysis was performed of 296 patients with stable angina pectoris who underwent physiological examinations before and after PCI. To investigate the differences of coronary flow improvement between territories with low‐FFR (<0.75) and grey‐zone FFR (0.75–0.80), serial changes in physiological indices including mean transit time (Tmn), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) were compared between these two groups. Results Compared to low‐FFR territories, grey‐zone FFR territories showed significantly lower prevalence of Tmn shortening, CFR improvement, and decrease in IMR (Tmn shorting, 63.9% vs. 87.0%, P < .001; CFR improvement, 63.0% vs. 75.7%, P = .019; IMR decrease, 51.3% vs. 63.3%, P = .040) and lower extent of their absolute changes (Tmn shorting, 0.06 (–0.03 to 0.16) vs. 0.22 (0.07–0.45), P < .001; CFR improvement, 0.45 (–0.32 to 1.87) vs. 1.08 (0.02–2.44), P < .01; IMR decrease, 0.2 (–44.0 to 31.3) vs. 2.9 (–2.9 to 11.8), P = .022). Multivariate analysis showed that pre‐PCI IMR predicted improved coronary flow profile in both groups, whereas pre‐PCI FFR predicted increased coronary flow indices in low‐FFR territories. Conclusions Worsening of physiological indices after PCI was not uncommon in territories showing grey‐zone FFR. Physiological assessment combining FFR and IMR may help identify patients who may benefit by PCI, particularly those in the grey zone.