Comparison of adenosine‐independent pressure indices to fractional flow reserve in stent‐jailed bifurcation side branches

Abstract

Objectives and Background: This study aims to evaluate whether the high correlation and classification agreement of the instantaneous wave-free ratio (iFR) and the resting distal coronary to aortic pressure ratio (P d /P a ) with the fractional flow reserve (FFR) can be confirmed in stent-jailed side branches (J-SB).Methods: Consecutive patients (n = 49) undergoing provisional stenting were prospectively enrolled and a physiological assessment of the J-SB (n = 51) was performed. FFR, iFR, and P d /P a were measured and the hemodynamic relevance was determined using cutoff values of ≤0.80, ≤0.89, and ≤0.92, respectively.Results: Both iFR (r = 0.75) and P d /P a (r = 0.77) correlated closely with FFR.Classification agreement with FFR was 78% for iFR (81% sensitivity, 77% specificity) and 75% for P d /P a (63% sensitivity and 80% specificity). However, angiographic diameter stenosis and pressure indices correlated poorly. For a threshold of ≥70% stenosis, agreement concerning hemodynamic relevance was found in 59% for FFR, 69% for iFR, and 61% for P d /P a . Conclusion:As reported for other lesion types, FFR and the adenosine-independent pressure indices iFR and P d /P a show close correlation and a high classification agreement of approximately 75%-80% in J-SB. Therefore, iFR can be regarded as a recommendable alternative to FFR for the guidance of provisional stenting in bifurcation lesions.