Key result
Fractional flow reserve identified a physiologically significant non-culprit LAD lesion that appeared insignificant on OCT and QCA, leading to successful stenting and a favorable short-term outcome.
Why the study?
Although studies have shown correlation between FFR and intravascular imaging to assess ischemic significance of intermediate coronary lesions, the correlation cannot be applied in all cases.
Case Report (n=1)
FFR may reveal physiologically significant lesions that appear insignificant on QCA and OCT, highlighting potential discrepancies between physiological and anatomical/imaging assessments.
FFR may uncover significant non-culprit lesions missed by OCT/QCA; single case leaves open need for prospective validation.
Fractional flow reserve (FFR) is a gold standard test to assess the physiological significance of an intermediate coronary lesion of 50–70% area stenosis. Recently, interventionist has tried to correlate and assess the ischemic significance of a lesion on the basis of intravascular imaging. Although most of the studies have shown moderate and significant correlation between FFR and intravascular imaging, the same cannot be applied for all the cases. We hereby report an unusual case of a non-culprit left anterior descending (LAD) lesion in a patient of ST elevation inferior wall myocardial infarction, which showed insignificant stenosis on quantitative coronary angiography (QCA) and optical coherence tomography (OCT) analysis; however, FFR revealed it as a significant physiological lesion. The patient had successful stenting of the LAD along with mid right coronary artery lesion and had a favorable short-term outcome.
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Vijayvergiya et al. (2018) conducted a case report in ST elevation inferior wall myocardial infarction with a non-culprit LAD lesion (n=1). Fractional flow reserve (FFR) and optical coherence tomography (OCT) was evaluated on Diagnostic assessment of lesion significance and short-term outcome. Fractional flow reserve identified a physiologically significant non-culprit LAD lesion that appeared insignificant on OCT and QCA, leading to successful stenting and a favorable short-term outcome.
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