Definite discordance between FFR and NHPR was associated with a higher 1-year risk of major adverse cardiac events compared to concordant negative lesions (aHR 1.98, P=0.029 and aHR 2.18, P=0.013).
Cohort (n=3,200)
Does definite or marginal discordance between FFR and NHPR impact the 1-year risk of major adverse cardiac events compared to concordant negative lesions?
Definite discordance between FFR and NHPR is associated with a significantly higher 1-year risk of major adverse cardiac events compared to concordant negative lesions, whereas marginal discordance is not.
Hazard Ratio: 1.98 (95% CI 1.07–3.68)
p-value: p=0.029
BACKGROUND: Fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPR) can show either marginal or definite discordance. OBJECTIVES: This study sought to investigate the clinical significance and factors associated with the magnitude of discordance between FFR and NHPR. METHODS: From the J-PRIDE registry, 4,304 lesions from 3,200 patients were categorized into 6 groups: (G1) definite FFR-/NHPR- (FFR ≥0.82 and NHPR ≥0.91), (G2) definite FFR+/NHPR+ (FFR ≤0.78 and NHPR ≤0.87), (G3) marginal discordant FFR+/NHPR- (FFR ≤0.80 and NHPR = 0.88-0.90, or FFR = 0.79-0.81 and NHPR >0.89), (G4) definite discordant FFR+/NHPR- (FFR ≤0.78 and NHPR ≥0.91), (G5) marginal discordant FFR-/NHPR+ (FFR = 0.79-0.81 and NHPR ≤0.89, or FFR >0.80 and NHPR = 0.88-0.90), and (G6) definite discordant FFR-/NHPR+ (FFR ≥0.82 and NHPR ≤0.87). The study endpoint was the cumulative 1-year incidence of major adverse cardiac events (defined as all-cause mortality, myocardial infarction, and clinically driven revascularization). RESULTS: Compared with G1, groups with definite discordance exhibited higher risks of major adverse cardiac events (G4, adjusted hazard ratio aHR: 1.98; 95% CI: 1.07-3.68; P = 0.029; and G6, aHR: 2.18; 95% CI: 1.18-4.04; P = 0.013), whereas those with marginal discordance (G3 and G5) did not. Additionally, G6 had an increased risk of all-cause mortality (aHR: 2.57; 95% CI: 1.19-5.56; P = 0.017). In FFR+/NHPR- lesions, G3 and G4 showed divergent associations with left anterior descending or left main coronary artery lesions and diameter stenosis. In FFR-/NHPR+ lesions, lower body mass index, diabetes mellitus, anemia, aortic stenosis, left ventricular hypertrophy, and in-stent restenosis were associated with G6, but not with G5. CONCLUSIONS: Definite discordance between FFR and NHPR differs from marginal discordance in terms of clinical prognosis and associated factors.
“Discordance should not be viewed simply as a disagreement between [two] numbers, nor as an opportunity to declare a winner between the [two] indices... [but instead as] a signal that the coronary circulation is more complex than a binary threshold can capture.”
Shiono et al. (Sat,) conducted a cohort in Coronary artery disease (n=3,200). Definite discordance between FFR and NHPR vs. Definite FFR-/NHPR- (concordant negative) was evaluated on Cumulative 1-year incidence of major adverse cardiac events (all-cause mortality, myocardial infarction, and clinically driven revascularization) (HR 1.98, 95% CI 1.07-3.68, p=0.029). Definite discordance between FFR and NHPR was associated with a higher 1-year risk of major adverse cardiac events compared to concordant negative lesions (aHR 1.98, P=0.029 and aHR 2.18, P=0.013).