Current Concepts of Integrated Coronary Physiology in the Catheterization Laboratory

Kern, Morton J.; Samady, Habib

doi:10.1016/j.jacc.2009.06.062

Cited by 263 publications

(174 citation statements)

References 65 publications

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“…Their study included 65 patients (63.1%) with ACS in whom the microvascular bed in the infarct zone may not have been uniform or constant or may have had minimal resistance. 26 Therefore, due to the theoretical limitations of FFR for ACS lesions, we excluded ACS lesions from the present study. The studies mentioned above included only intermediate coronary lesions, whereas in this study we investigated both angiographically determined severe stenoses and intermediate lesions.…”

Section: Discussionmentioning

confidence: 99%

“…However, an FFR value >0.80 is associated with negative ischemic testing with a predictive accuracy of 95%. 26 An FFR value between 0.75 and 0.80 is in the gray zone and requires clinical judgment. We conservatively considered the upper limit of the small transition zone to limit the number of potentially ischemic lesions left untreated as in the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) study.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Iguchi

Hasegawa

Nishimura

et al. 2012

Clinical Cardiology

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Background: Myocardial fractional flow reserve (FFR) is useful in the evaluation of coronary lesion ischemia. However, the impact of lesion length on FFR has not been adequately assessed. Hypothesis: We hypothesized that lesion length would influence functional significance in intermediate coronary lesions. Methods: FFR measurements were assessed in 136 patients (163 lesions) with stable angina who had >40% stenotic coronary lesion by quantitative coronary angiography (QCA). One hundred sixty-three lesions were classified as intermediate (40%-70% stenosis; n=107; group I) or significant (≥70%; n=56; group S) by QCA. We assessed the relationships between lesion length, coronary stenosis, and FFR in these 163 lesions. Results: Regression analysis revealed an inverse correlation between the percentage of diameter stenosis (%DS) and FFR in group S (r = −0.83, P < 0.0001). In group I, no significant correlation was found between %DS and FFR (r = −0.06, P = 0.55), whereas lesion length was significantly inversely correlated with FFR (r = −0.79, P < 0.0001). Receiver operating characteristic curve analysis demonstrated that the best cutoff value for predicting an FFR value <0.80 was a lesion length >16.1 mm in group I (sensitivity, 86%; specificity, 94%). Conclusions: These study findings suggest that lesion length has a physiologically significant impact on intermediate-grade coronary lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Iguchi

Hasegawa

Nishimura

et al. 2012

Clinical Cardiology

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“…It is well known that a discrepancy exists between angiographic stenosis severity and the presence of myocardial ischemia 2, 3, 4, 5, 6, 7, 8, 9, 10. This discrepancy cannot be completely resolved, even with more precise invasive imaging modalities, such as intravascular ultrasound or optical coherence tomography 11, 12, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Deferred Lesions With Angiographically Insignificant Stenosis But Low Fractional Flow Reserve

Lee

Koo

Shin

et al. 2017

JAHA

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BackgroundData are limited regarding outcomes of deferred lesions in patients with angiographically insignificant stenosis but low fractional flow reserve (FFR). We investigated the natural history of angiographically insignificant stenosis with low FFR among patients who underwent routine 3‐vessel FFR measurement.Methods and ResultsFrom December 2011 to March 2014, 1136 patients with 3298 vessels underwent routine 3‐vessel FFR measurement (3V FFR‐FRIENDS study, ClinicalTrials.gov identifier NCT01621438), and this study analyzed the 2‐year clinical outcomes of 1024 patients with 2124 lesions with angiographically insignificant stenosis (percentage of diameter stenosis <50%), in which revascularization was deferred. All lesions were classified according to FFR values, using a cutoff of 0.80 (high FFR >0.80 versus low FFR ≤0.80). The primary end point was outcome of major adverse cardiovascular events (a composite of cardiac death, myocardial infarction, and ischemia‐driven revascularization) at 2 years. Mean angiographic percentage of diameter stenosis and FFR of total lesions were 32.5±10.3% and 0.91±0.08%, respectively. Among the total lesions with angiographically insignificant stenosis, 8.7% showed low FFR (185 lesions). The incidence of lesions with low FFR was 2.5%, 3.8%, 9.0%, and 15.1% in categories of percentage of diameter stenosis <20%, 20% to 30%, 30% to 40%, and 40% to 50%, respectively. At 2‐year follow‐up, the low‐FFR group showed a significantly higher risk of major adverse cardiovascular events compared with the high FFR group (3.3% versus 1.2%, hazard ratio: 3.371; 95% CI, 1.346–8.442; P=0.009). In multivariable analysis, low FFR was the most powerful independent predictor of future MACE in deferred lesions with angiographically insignificant stenosis (adjusted hazard ratio: 2.617; 95% CI, 1.026–6.679; P=0.044).ConclusionsIn deferred angiographically insignificant stenosis, lesions with low FFR showed significantly higher event rates than those with high FFR. FFR was an independent predictor of future major adverse cardiovascular events in lesions with angiographically insignificant stenosis.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01621438.

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“…Alternatively, FFR may be used as the first modality to assess ambiguous left main severity, and the criteria for a significant stenosis are the same as for nonleft main stenosis. 21,36,37 Section 2: Tables 7 and 8 …”

Section: Table 6: Left Main Coronary Artery Stenosismentioning

confidence: 99%

ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease

Patel

Calhoon

Dehmer

et al. 2017

Journal of Nuclear Cardiology

110

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along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes and stable ischemic heart disease (SIHD) were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing SIHD and acute coronary syndromes individually. This document presents the AUC for SIHD.Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status; risk level as assessed by noninvasive testing; coronary disease burden; and, in some scenarios, fractional flow reserve ASNC testing, presence or absence of diabetes, and SYNTAX score. This update provides a reassessment of clinical scenarios that the writing group felt were affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization.A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range of 4 to 6 indicate that coronary revascularization may be appropriate for the clinical scenario.As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with high symptom burden, high-risk features, and high coronary disease burden, as well as in patients receiving antianginal therapy, are deemed appropriate. Additionally, scenarios assessing the appropriateness of revascularization before kidney transplantation or transcatheter valve therapy are now rated. The primary objective of the AUC is to provide a framework for the assessment of practice patterns that will hopefully improve physician decision making.

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Current Concepts of Integrated Coronary Physiology in the Catheterization Laboratory

Cited by 263 publications

References 65 publications

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Clinical Outcomes of Deferred Lesions With Angiographically Insignificant Stenosis But Low Fractional Flow Reserve

ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease

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