Agreement of Angiography-Derived and Wire-Based Fractional Flow Reserves in Percutaneous Coronary Intervention

Abstract

Background: Coronary angiography-derived fractional flow reserve (caFFR) measurements have shown good correlations and agreement with invasive wire-based fractional flow reserve (FFR) measurements. However, few studies have examined the diagnostic performance of caFFR measurements before and after percutaneous coronary intervention (PCI). This study sought to compare the diagnostic performance of caFFR measurements against wire-based FFR measurements in patients before and after PCI.Methods: Patients who underwent FFR-guided PCI were eligible for the acquisition of caFFR measurements. Offline caFFR measurements were performed by blinded hospital operators in a core laboratory. The primary endpoint was the vessel-oriented composite endpoint (VOCE), defined as a composite of vessel-related cardiovascular death, vessel-related myocardial infarction, and target vessel revascularization.Results: A total of 105 pre-PCI caFFR measurements and 65 post-PCI caFFR measurements were compared against available wire-based FFR measurements. A strong linear correlation was found between wire-based FFR and caFFR measurements (r = 0.77; p < 0.001) before PCI, and caFFR measurements also showed a high correlation (r = 0.82; p < 0.001) with wire-based FFR measurements after PCI. A total of 6 VOCEs were observed in 61 patients during follow-up. Post-PCI FFR values (≤0.82) in the target vessel was the strongest predictor of VOCE [hazard ratio (HR): 5.59; 95% confidence interval (CI): 1.12–27.96; p = 0.036). Similarly, patients with low post-PCI caFFR values (≤0.83) showed an 8-fold higher risk of VOCE than those with high post-PCI caFFR values (>0.83; HR: 8.83; 95% CI: 1.46–53.44; p = 0.017).Conclusion: The study showed that the caFFR measurements were well-correlated and in agreement with invasive wire-based FFR measurements before and after PCI. Similar to wire-based FFR measurements, post-PCI caFFR measurements can be used to identify patients with a higher risk for adverse events associated with PCI.

Current status and future perspectives of fractional flow reserve derived from invasive coronary angiography

“…In one smaller trial with 104 patients, caFFR was compared to invasive FFR before (104 patients) and after (65 patients) PCI. The authors reported a good correlation between caFFR and FFR measurements before ( r = 0.77; p < 0.001) and after ( r = 0.82; p < 0.001) stent implantation ( 21 ). Although they reported some adverse clinical outcomes to be related to low post-procedural caFFR, the number of events and participants is too low to draw such a conclusion, which should be addressed in larger prospective trials.…”

Complete revascularization based on angiography derived fractional flow reserve versus incomplete revascularization in patients with ST-segment elevation myocardial infarction

“…The caFFR, without using invasive pressure--wire measurement and hyperemic stimulus, overcomes these constraints and shows high diagnostic accuracy by using wire-derived FFR as the reference standard [8]. It has been confirmed that caFFR measurement is in good correlation and agreement with wire-based FFR both before and after PCI [8,[19][20][21]. Several studies proved that STEMI with multivessel disease patients can benefit from quantitative flow ratio-guided complete revascularization in the stages of acute MI [22][23][24].…”

The prognostic value and economic benefits of coronary angiography-derived fractional flow reserve-guided strategy in patients with coronary artery disease

“…Coronary Angiography-derived Fractional Flow Reserve (caFFR) is a new and practical technique to judge whether coronary artery stenosis is functional ischemia based on angiography in recent years, which can calculate the blood flow reserve fraction by using an optimized CAD algorithm without pressure guide wire and vasodilators. Compared with FFR, its accuracy and feasibility have been verified by a series of clinical trials [ [7] , [8] , [9] ]. However, it is unclear whether caFFR-guided PCI lesion selection can improve the prognosis compared with the standard angiographic guidance strategy in the real world.…”