- Email: [email protected]
AS-117 Long-Term Outcomes of Fractional Flow Reserve Guided Coronary Intervention in Consecutive ‘Real-World’ Patients
Wednesday, April 27 - Friday April 29, 2011 (Poster Abstract Zone) Background: It had been reported that the level of diameter stenosis (DS) by quantitative coronary angiography (QCA) had a correlation with the value of fractional flow reserve (FFR) in native coronary vessel. However, it was not well-known whether DS predicting FFR⬍0.75 were equally among LAD, LCX, and RCA. To evaluate correlations between the QCA and the FFR value in each coronary artery. Methods: Since August 2009, we consecutively performed coronary angiography and FFR measurements in 112 patients (140 vessels) with stable angina pectoris and analyzed the QCA value and the FFR value in these vessels. Results: Analyzed vessels were distributed LAD (52%), LCX (27%), and RCA (21%). There were no differences among them in DS (57⫾14% vs 62⫾13% vs 62⫾12%, p⫽ns, respectively), lesion length (20⫾13mm vs 19⫾9mm vs 15⫾7mm, p⫽ns, respectively). However, there was a significant difference in the FFR value among them (0.73⫾ 0.12 vs 0.78⫾0.15 vs 0.82⫾0.12, p⫽0.01, respectively). The best value of DS predicting FFR⬍0.75 were 44% (sensitivity 95%, specificity 38%) in LAD, 63% (sensitivity 79%, specificity 62%) in LCX, and 65% (sensitivity 100%, specificity 70%) in RCA. Conclusion: We might overestimate myocardial ischemia in LCX and RCA, and underestimate it in LAD, when we considered %DS⬎ 50% as positive. Thus, we correctly had to estimate the degree of stenosis in each coronary artery.
AS-113
P O S T E R A B S T R A C T S
Relationship between Angiographic Assessment by Quantitative Coronary Analysis and the Value of Fractional Flow Reserve in Coronary Artery Diseases. Akiyoshi Kurita, Hiroaki Takashima, Tomofumi Mizuno, Kenji Asai, Yasuo Kuroda, Yoshinori Wakita, Takashi Kosaka, Tasushi Kuhara, Kazuyuki Maeda, Sinichirou Sakurai, Yukiko Toda, Daiki Kato, Tesu Sou, Takayuki Itou. Aichi Medical University, Aichi, Japan. Background: Although it is recognized that the level of diameter stenosis (DS) by quantitative coronary angiography (QCA) is correlated with the value of fractional flow reserve (FFR), some cases show the discrepancy of them. To evaluate relationship between various angiographic measurements by QCA and the value of FFR in coronary artery diseases. Methods: Since August 2009, we consecutively performed coronary angiography and FFR measurements in 112 patients 140 vessels with stable angina pectoris. We analyzed the QCA value and the FFR value in these vessels. Results: Analyzed vessels were distributed in LAD (52%), LCX (27%), and RCA (21%), respectively. In all coronary vessels, there were significant negative correlations between DS, lesion length (LL) and the FFR value (r⫽-0.46, p⬍0.0001 and r⫽-0.38, p⬍0.0001, respectively). There was a significant positive correlation between minimal lumen diameter (MLD) and the FFR value (r⫽0.50, p⬍0.0001), although no correlation with reference diameter (RD) (r⫽0.16, p⫽ 0.06). Furthermore, we calculated DSLL index which was defined as %DS times LL. DSLL showed strongly negative correlation with the FFR value (r⫽-0.51, p⬍0.0001). The cut off level of DS, LL, and DSLL predicting FFR⬍0.75 were 61.8% (sensitivity 66%, specificity 68%), 17.12mm (sensitivity 75%, specificity 65%), and 993.6 (sensitivity 78%, specificity 69%), respectively. Conclusion: This study suggested that the value of FFR greatly associated with DSLL index more than DS or LL.
114A
AS-114 Comparison between Central and Peripheral Vein Approach to Infuse Intravenous Adenosine in Fractional Flow Reserve Measurement. Hiroaki Takashima, Akiyoshi Kurita, Tomofumi Mizuno, Kenji Asai, Yasuo Kuroda, Yoshinori Wakita, Takashi Kosaka, Yasushi Kuhara, Kazuyuki Maeda, Shin-ichiro Sakurai, Yukiko Toda, Daiki Kato, Tesu Soe, Shingo Yamada, Takayuki Ito. Aichi Medical University, Aichi, Japan. Background: Fractional flow reserve (FFR) has been recognized as utility tool to evaluate the severity of coronary artery disease in the viewpoint of physiological lesion assessment. In FFR measurements, continuous intravenous adenosine triphosphate (ATP) infusion has been recommended to obtain hyperemia. However, it is not well-known whether the different approach may induce the discrepancy in the FFR value and the achieving time to maximal hyperemia. Thus, we evaluated that the FFR value and the achieving time to maximal hyperemia between central vein (CV) and peripheral vein (PV) approach to infuse intravenous ATP. Methods: We examined coronary pressure measurements with certusTM wire in 14 patients (16 moderate coronary lesions). After pressure wire was positioned as distal as possible in a coronary artery, we measured, all patients were given intravenous ATP (150/kg/min) approached from CV or PV to obtain maximal hyperemia. We measured the achieving time to maximal hyperemia and the FFR value. After 5 to10 minutes, they were given same agents approached from the other vein, and measured them. Results: Analyzed vessels were distributed in LAD (50%), LCX (44%), and RCA (6%), respectively. In quantitative coronary angiography analysis, reference diameter was 2.39⫾0.58mm and %diameter stenosis was 56⫾14%. There was occurred only one transient AV block in both access methods. The FFR value had no difference between CV and PV approach (0.79⫾0.10 vs. 0.80⫾0.11, p⫽0.59). However, the achieving time to maximal hyperemia was significantly shorter in CV approach compared with PV approach (79⫾36 vs. 102⫾42 sec, p⫽0.03). Conclusion: This study suggested that ATP infusion from PV approach would be adequately feasible to obtain maximal hyperemia, although ATP infusion from CV approach might take a little advantage on the achieving time to maximal hyperemia.
AS-117 Long-Term Outcomes of Fractional Flow Reserve Guided Coronary Intervention in Consecutive ‘Real-World’ Patients. Michael Liang1, Damian Kelly1, Aniket Puri2, Suresh Perera1, Madhav Menon1, Gerard Devlin1. 1Waikato Hospital, Hamilton, New Zealand; 2King George Medical University, Lucknow, India. Background: Fractional flow reserve (FFR) is an invasive physiological measurement of coronary artery stenoses. Randomised trial data has demonstrated an FFR⬎0.80 predicts excellent clinical outcomes in medically managed patients. However, limited information exist on how these trials translate to unselected ‘real-world’ clinical practice. This study aims to determine longer-term clinical outcome among consecutive patients with angiographic coronary artery disease (CAD) in whom coronary angiography demonstrated non flow-limiting stenoses (FFR⬎0.80) and who did not undergo percutaneous coronary intervention (PCI). Methods: Consecutive patients with symptomatic CAD undergoing coronary angiography with pressure-wire interrogation between January 2006 and May 2010 were identified. Clinical outcomes were assessed in patients with FFR⬎0.80 who did not undergo PCI. These included the presence of anginal chest pain, need for revascularization or death during a median follow-up of 17⫾9 months.
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
Wednesday, April 27 - Friday April 29, 2011 (Poster Abstract Zone) Results: 325 lesions were interrogated in 273 consecutive patients. FFR was ⬎0.80 (mean 0.89⫾0.05) in 190 patients (69.6%) and 228 lesions (83.5%). Of these 190 patients; there were 16% diabetic, 54% dyslipidiaemic, 55% hypertensive, and 34% smokers. Lesions were in the LAD in 53%, Circumflex in 25%, RCA in 16% and left main stem in 7%. Recurrence of angina was seen in 10.5% of patients with 5.8% reporting atypical chest pain. No myocardial infarction was noted. Revascularization was required in 6.3% with one cardiovascular death (0.5%) due to heart failure.
Conclusion: An FFR⬎0.80 in symptomatic patients with CAD predicts an excellent longer term mortality outcome with conservative management in unselected patients. Recurrent chest discomfort was noted in 1 in 6 patients however revascularisation was undertaken infrequently. This real world study confirms the utility of FFR in preventing unnecessary interventions in equivocal lesions.
P O S T E R A B S T R A C T S
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
115A
AS-113
P O S T E R A B S T R A C T S
Relationship between Angiographic Assessment by Quantitative Coronary Analysis and the Value of Fractional Flow Reserve in Coronary Artery Diseases. Akiyoshi Kurita, Hiroaki Takashima, Tomofumi Mizuno, Kenji Asai, Yasuo Kuroda, Yoshinori Wakita, Takashi Kosaka, Tasushi Kuhara, Kazuyuki Maeda, Sinichirou Sakurai, Yukiko Toda, Daiki Kato, Tesu Sou, Takayuki Itou. Aichi Medical University, Aichi, Japan. Background: Although it is recognized that the level of diameter stenosis (DS) by quantitative coronary angiography (QCA) is correlated with the value of fractional flow reserve (FFR), some cases show the discrepancy of them. To evaluate relationship between various angiographic measurements by QCA and the value of FFR in coronary artery diseases. Methods: Since August 2009, we consecutively performed coronary angiography and FFR measurements in 112 patients 140 vessels with stable angina pectoris. We analyzed the QCA value and the FFR value in these vessels. Results: Analyzed vessels were distributed in LAD (52%), LCX (27%), and RCA (21%), respectively. In all coronary vessels, there were significant negative correlations between DS, lesion length (LL) and the FFR value (r⫽-0.46, p⬍0.0001 and r⫽-0.38, p⬍0.0001, respectively). There was a significant positive correlation between minimal lumen diameter (MLD) and the FFR value (r⫽0.50, p⬍0.0001), although no correlation with reference diameter (RD) (r⫽0.16, p⫽ 0.06). Furthermore, we calculated DSLL index which was defined as %DS times LL. DSLL showed strongly negative correlation with the FFR value (r⫽-0.51, p⬍0.0001). The cut off level of DS, LL, and DSLL predicting FFR⬍0.75 were 61.8% (sensitivity 66%, specificity 68%), 17.12mm (sensitivity 75%, specificity 65%), and 993.6 (sensitivity 78%, specificity 69%), respectively. Conclusion: This study suggested that the value of FFR greatly associated with DSLL index more than DS or LL.
114A
AS-114 Comparison between Central and Peripheral Vein Approach to Infuse Intravenous Adenosine in Fractional Flow Reserve Measurement. Hiroaki Takashima, Akiyoshi Kurita, Tomofumi Mizuno, Kenji Asai, Yasuo Kuroda, Yoshinori Wakita, Takashi Kosaka, Yasushi Kuhara, Kazuyuki Maeda, Shin-ichiro Sakurai, Yukiko Toda, Daiki Kato, Tesu Soe, Shingo Yamada, Takayuki Ito. Aichi Medical University, Aichi, Japan. Background: Fractional flow reserve (FFR) has been recognized as utility tool to evaluate the severity of coronary artery disease in the viewpoint of physiological lesion assessment. In FFR measurements, continuous intravenous adenosine triphosphate (ATP) infusion has been recommended to obtain hyperemia. However, it is not well-known whether the different approach may induce the discrepancy in the FFR value and the achieving time to maximal hyperemia. Thus, we evaluated that the FFR value and the achieving time to maximal hyperemia between central vein (CV) and peripheral vein (PV) approach to infuse intravenous ATP. Methods: We examined coronary pressure measurements with certusTM wire in 14 patients (16 moderate coronary lesions). After pressure wire was positioned as distal as possible in a coronary artery, we measured, all patients were given intravenous ATP (150/kg/min) approached from CV or PV to obtain maximal hyperemia. We measured the achieving time to maximal hyperemia and the FFR value. After 5 to10 minutes, they were given same agents approached from the other vein, and measured them. Results: Analyzed vessels were distributed in LAD (50%), LCX (44%), and RCA (6%), respectively. In quantitative coronary angiography analysis, reference diameter was 2.39⫾0.58mm and %diameter stenosis was 56⫾14%. There was occurred only one transient AV block in both access methods. The FFR value had no difference between CV and PV approach (0.79⫾0.10 vs. 0.80⫾0.11, p⫽0.59). However, the achieving time to maximal hyperemia was significantly shorter in CV approach compared with PV approach (79⫾36 vs. 102⫾42 sec, p⫽0.03). Conclusion: This study suggested that ATP infusion from PV approach would be adequately feasible to obtain maximal hyperemia, although ATP infusion from CV approach might take a little advantage on the achieving time to maximal hyperemia.
AS-117 Long-Term Outcomes of Fractional Flow Reserve Guided Coronary Intervention in Consecutive ‘Real-World’ Patients. Michael Liang1, Damian Kelly1, Aniket Puri2, Suresh Perera1, Madhav Menon1, Gerard Devlin1. 1Waikato Hospital, Hamilton, New Zealand; 2King George Medical University, Lucknow, India. Background: Fractional flow reserve (FFR) is an invasive physiological measurement of coronary artery stenoses. Randomised trial data has demonstrated an FFR⬎0.80 predicts excellent clinical outcomes in medically managed patients. However, limited information exist on how these trials translate to unselected ‘real-world’ clinical practice. This study aims to determine longer-term clinical outcome among consecutive patients with angiographic coronary artery disease (CAD) in whom coronary angiography demonstrated non flow-limiting stenoses (FFR⬎0.80) and who did not undergo percutaneous coronary intervention (PCI). Methods: Consecutive patients with symptomatic CAD undergoing coronary angiography with pressure-wire interrogation between January 2006 and May 2010 were identified. Clinical outcomes were assessed in patients with FFR⬎0.80 who did not undergo PCI. These included the presence of anginal chest pain, need for revascularization or death during a median follow-up of 17⫾9 months.
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
Wednesday, April 27 - Friday April 29, 2011 (Poster Abstract Zone) Results: 325 lesions were interrogated in 273 consecutive patients. FFR was ⬎0.80 (mean 0.89⫾0.05) in 190 patients (69.6%) and 228 lesions (83.5%). Of these 190 patients; there were 16% diabetic, 54% dyslipidiaemic, 55% hypertensive, and 34% smokers. Lesions were in the LAD in 53%, Circumflex in 25%, RCA in 16% and left main stem in 7%. Recurrence of angina was seen in 10.5% of patients with 5.8% reporting atypical chest pain. No myocardial infarction was noted. Revascularization was required in 6.3% with one cardiovascular death (0.5%) due to heart failure.
Conclusion: An FFR⬎0.80 in symptomatic patients with CAD predicts an excellent longer term mortality outcome with conservative management in unselected patients. Recurrent chest discomfort was noted in 1 in 6 patients however revascularisation was undertaken infrequently. This real world study confirms the utility of FFR in preventing unnecessary interventions in equivocal lesions.
P O S T E R A B S T R A C T S
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
115A