Key result
Lowering the FFR cutoff to <0.75 reduces diagnostic accuracy for ischemia in post-ACS non-culprit lesions.
Why the study?
Comparisons of fractional flow reserve (FFR) to dobutamine stress echocardiography (DSE) in patients with acute coronary syndrome (ACS) and non-culprit lesions (NCLs) are lacking.
Does the diagnostic performance of FFR relative to DSE differ between moderate non-culprit lesions in ACS patients and stable lesions in stable angina patients?
Observational (n=175)
Blinded to comparator results (imaging cardiologists blinded to QCA/FFR; interventional cardiologists blinded to DSE)
No
Does the diagnostic performance of FFR relative to DSE differ between moderate non-culprit lesions in ACS patients and stable lesions in stable angina patients?
FFR assessment may have different diagnostic relevance and poorer correlation with DSE in moderate non-culprit lesions of ACS patients compared to stable lesions in stable angina patients.
Lowering FFR cutoff to 0.75 may reduce DSE discrimination in ACS non-culprit lesions; hypothesis-generating for tailored thresholds.
Fractional flow reserve (FFR) measurement was compared to dobutamine stress echocardiography (DSE) instable angina (SA) with stable coronary lesion (s) (SCL (s) ) in a few trials; however, similar comparisons in patients with acute coronary syndrome (ACS) with non-culprit lesion (s) (NCL (s) ) are lacking. Our objectives were to prospectively evaluate the diagnostic performance of FFR with two different cutoff values (< 0.80 and < 0.75) relative to DSE in moderate (30%-70% diameter stenosis) NCLs (ACS group) and to compare these observations with those measured in SCLs (SA group). One hundred seventy-five consecutive patients with SA (n = 86) and ACS (n = 89) with 225 coronary lesions (109 SCLs and 116 NCLs) were enrolled. In contrast to the ACS cohort in SA patients, normal DSE was associated with higher FFR values compared to those with abnormal DSE (P = 0.051 versus P = 0.006). In addition, in the SA group, a significant correlation was observed between DSE (regional wall motion score index at peak stress) and FFR (r = -0.290; P = 0.002), whereas a similar association was absent (r = -0.029; P = 0.760) among ACS patients. In the SA group, decreasing the FFR cutoff value (< 0.80 versus < 0.75) improved the concordance of FFR with DSE (70.6% versus 81.7%) without altering its discriminatory power (area under the curve; 0.68 versus 0.63; P = 0.369), whereas in the ACS group, concordance remained similar (69.0% versus 71.6%) and discriminatory power decreased (0.62 versus 0.51; P = 0.049), respectively. In conclusion, lesion-specific FFR assessment may have different relevance in patients with moderate NCLs than in patients with SCLs.
No takes yet. Share an insight, caveat, or question.
Ahres et al. (2021) conducted an observational in Moderate non-culprit coronary lesions in recent acute coronary syndrome and stable coronary lesions in stable angina (n=175). Fractional flow reserve (FFR) cutoff < 0.75 vs. Fractional flow reserve (FFR) cutoff < 0.80 was evaluated on Discriminatory power (AUC) for predicting abnormal dobutamine stress echocardiography in the ACS group (p=0.049). In patients with recent acute coronary syndrome and moderate non-culprit lesions, lowering the fractional flow reserve cutoff from <0.80 to <0.75 decreased its discriminatory power relative to dobutamine stress echocardiography (AUC 0.62 vs 0.51, p=0.049).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: