Effect of Sex Difference on Discordance Between Instantaneous Wave-Free Ratio and Fractional Flow Reserve

• Published in: Cardiovascular revascularization medicine Vol. 24; pp. 57 - 64
• Main Authors: Aoi, Shunsuke, Toklu, Bora, Misumida, Naoki, Patel, Neil, Lee, Wonkyoung, Fox, John, Matsuo, Hitoshi, Kanei, Yumiko
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2021
• Subjects: Coronary artery disease; Fractional flow reserve; Instantaneous wave-free ratio; Sex difference; ACS; Instantaneous wave-free ratio; FFR; iFR; MACE; PCI; Fractional flow reserve; Coronary artery disease; Sex difference; CFR; LAD; CTO
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2020.08.013

Physiology-guided percutaneous coronary intervention (PCI) has demonstrated to improve clinical outcomes. Previous trials showed the agreement between iFR and FFR is approximately 80%, however the details of discordance pattern remain to be elucidated. We retrospectively reviewed 1024 consecutive intermediate stenotic lesions for which functional evaluation using both iFR and FFR were performed between January 2015 and June 2016. The lesions were classified into 4 groups according to iFR and FFR concordance [(iFR+/FFR+) and (iFR-/FFR-)] or discordance [(iFR+/FFR-) and (iFR-/FFR+)]. Our study evaluated 451 lesions, 264 lesions (58.5%) from men and 187 lesions (41.5%) from women. iFR was similar between women and men, however FFR was significantly higher in women than men. The rate of discordance between iFR and FFR was 21.3% (iFR+/FFR- 12.4% and iFR-/FFR+ 8.9%) in overall cohort. The prevalence of overall concordance and discordance were similar between men and women, however iFR+/FFR- discordance was significantly higher in women (17.1% vs. 9.1%) whereas iFR-/FFR+ discordance was significantly higher in men (11.3% vs. 4.8%). In multivariable analysis, female sex and older age were significantly associated with iFR+/FFR- discordance (odds ratio 1.88 and 1.48, respectively). Conversely, younger age, higher stenosis, and concomitant chronic total occlusion were independent predictors for iFR-/FFR+ discordance (odds ratio 0.67, 1.82, and 4.32, respectively). Despite similar prevalence of overall concordance and discordance between men and women, iFR+/FFR- discordance was higher in women and iFR-/FFR+ discordance was higher in men. Multivariable analysis showed female sex to be independent predictor of iFR+/FFR- discordance. •iFR and FFR were discordant in 21.3% of the total lesions•FFR value was higher in women whereas iFR value was similar between the sexes•Women had more iFR+/FFR- discordance and female sex was an independent predictor of iFR+/FFR- discordance