Impact of Age on the Functional Evaluation of Intermediate Coronary Stenoses With Instantaneous Wave-Free Ratio and Fractional Flow Reserve

Aim: Instantaneous wave-free ratio (iFR) has emerged as the strategy of choice for the assessment of intermediate coronary lesions. The impact of preprocedural β-blockers therapy on the iFR was the aim of this study. Methods: We included patients undergoing functional assessment of intermediate (40%-70%) coronary lesions in 2 centers. The iFR measurement was performed by pressure-recording guidewire and calculated at the core laboratory using the manufacturers’ dedicated software. Minimal luminal diameter, reference diameter, percent diameter stenosis, and length of the lesion were measured. Positive iFR was considered for values <0.90. Results: We included 197 patients undergoing functional evaluation of 223 coronary lesions. Patients on β-blockers (69%) had more frequently hypertension ( P = .05); previous myocardial infarction ( P = .01); therapy with clopidogrel ( P = .02), statins, and aspirin; and acute coronary syndrome at presentation ( P < .001, respectively). Mean iFR values were slightly higher in patients on β-blockers (0.94 ± 0.06 vs 0.92 ± 0.06, P = .11). The rate of positive iFR was significantly lower with β-blockers (14.9% vs 27.5%, P = .04). On multivariate analysis, β-blockers use was a predictor of the significance of coronary stenoses (odds ratio [OR] = 0.48; 95% CI = 0.23-0.98; P = .05) together with lesion length (OR = 1.04; 95% CI = 1.01-1.07; P = .007). Conclusion: Among patients undergoing iFR, preprocedural β-blockers are associated with higher absolute values and a lower rate of positive iFR.

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“…A coronary stenosis was considered significant for iFR < 0.90 according to the previous literature. 19,20…”

Section: Instantaneous Wave-free Ratio Assessmentmentioning

confidence: 99%

Preprocedural β-Blockers in the Functional Assessment of Intermediate Coronary Lesions by Instantaneous Wave-Free Ratio

et al. 2021

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“…Quantitative coronary angiography was performed by experienced interventional cardiologists, by an automatic edge-detection system (a software associated with the angiographer). 17 We measured minimal luminal diameter (MLD), reference diameter (RD), percent diameter stenosis, and length of the lesion. In previously bypassed patients, both native arteries and grafts were taken into account in the evaluation of extension of coronary artery disease (number of diseased vessels).…”

Section: Coronary Angiographymentioning

confidence: 99%

Long-Term Outcomes With Drug-Eluting Balloon for the Treatment of In-Stent Restenosis and De Novo Lesions: The Novara-Biella-Trento (NOBITRE) Registry

et al. 2022

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Drug-coated balloons (DCBs) have emerged for percutaneous coronary interventions (PCI) of in-stent restenosis or particular anatomical subsets. We provide a real-world analysis of the prognostic determinants and long-term outcomes of patients treated with DCB for any lesion in a comprehensive multicenter registry. The primary study endpoint was the occurrence of major cardiovascular events (MACE: composite of all-cause death, myocardial infarction, and target vessel revascularization) at the longest available follow-up. We included 267 patients (196 treated for in-stent restenosis and 71 for de novo lesions), with a median follow-up of 616 [368–1025] days. MACE occurred in 70 (26.2%) of the patients and related with higher rates of in-stent restenosis (P = .04), longer and more type C lesions ( P = .05 and P = .04). At multivariate Cox-regression, type C lesions emerged as the only independent predictor of MACE (adjusted OR [95% CI] = 1.83[1.13–2.97], P = .014), mainly driven by target vessel revascularization (adjusted OR[95% CI] = 1.78[1.05–2.95], P = .03) not conditioning survival. In-stent restenosis emerged as major determinant of TLF (adjusted OR[95% CI] = 2.59[1.17–5.75], P = .02). DCBs represent a treatment option for any lesion; however, type C and restenotic lesions are associated with an increased risk of MACE and target lesion failure, where the optimal strategies for patients’ selection and lesion preparation are still undefined.

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“…This hypothesis is supported by a significantly larger decrease of FFR-values in younger patients after administration of increasing doses of adenosine. 39 These differences might lead to undertreatment of coronary lesions in elderly patients when using FFR. On the other hand, the possible impact of diseased microvasculature on FFR-measurements is subject of continued debate.…”

Section: Practical Aspects and Patient Selectionmentioning

confidence: 99%

“…Multiple studies have shown that FFRvalues increase with age, independently of other factors such as stenosis severity. [38][39][40] The difference between resting pressure and pressure during maximal hyperemia is lower in elderly patients. 38,40 A significantly higher FFR has been observed for similar degrees of stenosis and lesion length in older patients (>70 years of age) compared to younger patients (<70 years).…”

Section: Elderly Patientsmentioning

confidence: 99%

Fractional Flow Reserve: Patient Selection and Perspectives

Peper

Becker

Kuijk

et al. 2021

VHRM

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Impact of Age on the Functional Evaluation of Intermediate Coronary Stenoses With Instantaneous Wave-Free Ratio and Fractional Flow Reserve

Cited by 7 publications

References 35 publications

Preprocedural β-Blockers in the Functional Assessment of Intermediate Coronary Lesions by Instantaneous Wave-Free Ratio

Preprocedural β-Blockers in the Functional Assessment of Intermediate Coronary Lesions by Instantaneous Wave-Free Ratio

Long-Term Outcomes With Drug-Eluting Balloon for the Treatment of In-Stent Restenosis and De Novo Lesions: The Novara-Biella-Trento (NOBITRE) Registry

Fractional Flow Reserve: Patient Selection and Perspectives

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