Characteristics of Function-Anatomy Mismatch in Patients with Coronary Artery Disease
Coronary lesions with mismatched functional and anatomical significance are not uncommon. We assessed the accuracy and predictors of mismatch between fractional flow reserve (FFR) and quantitative coronary angiography (QCA) analyses in patients with coronary lesions. A total of 643 lesions with pre-...
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| Published in | Korean circulation journal Vol. 44; no. 6; pp. 394 - 399 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Korea (South)
The Korean Society of Cardiology
01.11.2014
대한심장학회 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1738-5520 1738-5555 |
| DOI | 10.4070/kcj.2014.44.6.394 |
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| Abstract | Coronary lesions with mismatched functional and anatomical significance are not uncommon. We assessed the accuracy and predictors of mismatch between fractional flow reserve (FFR) and quantitative coronary angiography (QCA) analyses in patients with coronary lesions.
A total of 643 lesions with pre-interventional FFR and QCA measurements were consecutively enrolled and divided into four groups using FFR ≤0.80 and percent diameter stenosis (%DS) ≥50% as cutoffs for functional and anatomical significance, respectively. Accordingly, FFR >0.80 and DS ≥50%, and FFR ≤0.80 and DS <50% defined false-positive (FP) and false-negative (FN) lesions, respectively.
Overall, 40.4% (260/643) of the lesions were mismatched, and 51.7% (218/414) and 18.3% (42/229) were FP and FN lesions, respectively. In a multivariate analysis, independent predictors of FP were non-left anterior descending artery location {odds ratio (OR), 0.36; 95% confidence interval (CI), 0.28-0.56; p<0.001}, shorter lesion length (OR, 0.96; 95% CI, 0.95-0.98; p<0.001), multi-vessel disease (OR, 0.47; 95% CI, 0.30-0.75; p=0.001), and larger minimal lumen diameter by QCA (OR, 2.88; 95% CI,1.65-5.00; p<0.001). Independent predictors of FN were multi-vessel disease (OR, 1.82; 95% CI, 1.24-5.27; p=0.048), aging (OR, 0.96; 95% CI, 0.93-0.99; p=0.034), smoking (OR, 0.36; 95% CI, 0.14-0.93; p=0.034), and smaller reference vessel diameter by QCA (OR, 0.30; 95% CI, 0.10-0.87; p=0.026).
A mismatch between FFR and angiographic lesion severity is not rare in patients with coronary artery disease; therefore, an angiography-guided evaluation could under- or over-estimate lesion severity in specific lesion subsets. |
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| AbstractList | Background and Objectives: Coronary lesions with mismatched functional and anatomical significance are not uncommon. We assessed the accuracy and predictors of mismatch between fractional flow reserve (FFR) and quantitative coronary angiography (QCA) analyses in patients with coronary lesions.
Subjects and Methods: A total of 643 lesions with pre-interventional FFR and QCA measurements were consecutively enrolled and divided into four groups using FFR ≤0.80 and percent diameter stenosis (%DS) ≥50% as cutoffs for functional and anatomical significance, respectively. Accordingly, FFR >0.80 and DS ≥50%, and FFR ≤0.80 and DS <50% defined false-positive (FP) and false-negative (FN) lesions, respectively.
Results: Overall, 40.4% (260/643) of the lesions were mismatched, and 51.7% (218/414) and 18.3% (42/229) were FP and FN lesions, respectively.
In a multivariate analysis, independent predictors of FP were non-left anterior descending artery location {odds ratio (OR), 0.36; 95% confidence interval (CI), 0.28–0.56; p<0.001}, shorter lesion length (OR, 0.96; 95% CI, 0.95–0.98; p<0.001), multi-vessel disease (OR, 0.47; 95% CI, 0.30–0.75; p=0.001), and larger minimal lumen diameter by QCA (OR, 2.88; 95% CI,1.65–5.00; p<0.001). Independent predictors of FN were multi-vessel disease (OR, 1.82; 95% CI, 1.24–5.27; p=0.048), aging (OR, 0.96; 95% CI, 0.93–0.99; p=0.034), smoking (OR, 0.36; 95% CI, 0.14–0.93; p=0.034), and smaller reference vessel diameter by QCA (OR, 0.30; 95% CI, 0.10–0.87; p=0.026).
Conclusion: A mismatch between FFR and angiographic lesion severity is not rare in patients with coronary artery disease; therefore, an angiography- guided evaluation could under- or over-estimate lesion severity in specific lesion subsets. KCI Citation Count: 11 Coronary lesions with mismatched functional and anatomical significance are not uncommon. We assessed the accuracy and predictors of mismatch between fractional flow reserve (FFR) and quantitative coronary angiography (QCA) analyses in patients with coronary lesions. A total of 643 lesions with pre-interventional FFR and QCA measurements were consecutively enrolled and divided into four groups using FFR ≤0.80 and percent diameter stenosis (%DS) ≥50% as cutoffs for functional and anatomical significance, respectively. Accordingly, FFR >0.80 and DS ≥50%, and FFR ≤0.80 and DS <50% defined false-positive (FP) and false-negative (FN) lesions, respectively. Overall, 40.4% (260/643) of the lesions were mismatched, and 51.7% (218/414) and 18.3% (42/229) were FP and FN lesions, respectively. In a multivariate analysis, independent predictors of FP were non-left anterior descending artery location {odds ratio (OR), 0.36; 95% confidence interval (CI), 0.28-0.56; p<0.001}, shorter lesion length (OR, 0.96; 95% CI, 0.95-0.98; p<0.001), multi-vessel disease (OR, 0.47; 95% CI, 0.30-0.75; p=0.001), and larger minimal lumen diameter by QCA (OR, 2.88; 95% CI,1.65-5.00; p<0.001). Independent predictors of FN were multi-vessel disease (OR, 1.82; 95% CI, 1.24-5.27; p=0.048), aging (OR, 0.96; 95% CI, 0.93-0.99; p=0.034), smoking (OR, 0.36; 95% CI, 0.14-0.93; p=0.034), and smaller reference vessel diameter by QCA (OR, 0.30; 95% CI, 0.10-0.87; p=0.026). A mismatch between FFR and angiographic lesion severity is not rare in patients with coronary artery disease; therefore, an angiography-guided evaluation could under- or over-estimate lesion severity in specific lesion subsets. Coronary lesions with mismatched functional and anatomical significance are not uncommon. We assessed the accuracy and predictors of mismatch between fractional flow reserve (FFR) and quantitative coronary angiography (QCA) analyses in patients with coronary lesions.BACKGROUND AND OBJECTIVESCoronary lesions with mismatched functional and anatomical significance are not uncommon. We assessed the accuracy and predictors of mismatch between fractional flow reserve (FFR) and quantitative coronary angiography (QCA) analyses in patients with coronary lesions.A total of 643 lesions with pre-interventional FFR and QCA measurements were consecutively enrolled and divided into four groups using FFR ≤0.80 and percent diameter stenosis (%DS) ≥50% as cutoffs for functional and anatomical significance, respectively. Accordingly, FFR >0.80 and DS ≥50%, and FFR ≤0.80 and DS <50% defined false-positive (FP) and false-negative (FN) lesions, respectively.SUBJECTS AND METHODSA total of 643 lesions with pre-interventional FFR and QCA measurements were consecutively enrolled and divided into four groups using FFR ≤0.80 and percent diameter stenosis (%DS) ≥50% as cutoffs for functional and anatomical significance, respectively. Accordingly, FFR >0.80 and DS ≥50%, and FFR ≤0.80 and DS <50% defined false-positive (FP) and false-negative (FN) lesions, respectively.Overall, 40.4% (260/643) of the lesions were mismatched, and 51.7% (218/414) and 18.3% (42/229) were FP and FN lesions, respectively. In a multivariate analysis, independent predictors of FP were non-left anterior descending artery location {odds ratio (OR), 0.36; 95% confidence interval (CI), 0.28-0.56; p<0.001}, shorter lesion length (OR, 0.96; 95% CI, 0.95-0.98; p<0.001), multi-vessel disease (OR, 0.47; 95% CI, 0.30-0.75; p=0.001), and larger minimal lumen diameter by QCA (OR, 2.88; 95% CI,1.65-5.00; p<0.001). Independent predictors of FN were multi-vessel disease (OR, 1.82; 95% CI, 1.24-5.27; p=0.048), aging (OR, 0.96; 95% CI, 0.93-0.99; p=0.034), smoking (OR, 0.36; 95% CI, 0.14-0.93; p=0.034), and smaller reference vessel diameter by QCA (OR, 0.30; 95% CI, 0.10-0.87; p=0.026).RESULTSOverall, 40.4% (260/643) of the lesions were mismatched, and 51.7% (218/414) and 18.3% (42/229) were FP and FN lesions, respectively. In a multivariate analysis, independent predictors of FP were non-left anterior descending artery location {odds ratio (OR), 0.36; 95% confidence interval (CI), 0.28-0.56; p<0.001}, shorter lesion length (OR, 0.96; 95% CI, 0.95-0.98; p<0.001), multi-vessel disease (OR, 0.47; 95% CI, 0.30-0.75; p=0.001), and larger minimal lumen diameter by QCA (OR, 2.88; 95% CI,1.65-5.00; p<0.001). Independent predictors of FN were multi-vessel disease (OR, 1.82; 95% CI, 1.24-5.27; p=0.048), aging (OR, 0.96; 95% CI, 0.93-0.99; p=0.034), smoking (OR, 0.36; 95% CI, 0.14-0.93; p=0.034), and smaller reference vessel diameter by QCA (OR, 0.30; 95% CI, 0.10-0.87; p=0.026).A mismatch between FFR and angiographic lesion severity is not rare in patients with coronary artery disease; therefore, an angiography-guided evaluation could under- or over-estimate lesion severity in specific lesion subsets.CONCLUSIONA mismatch between FFR and angiographic lesion severity is not rare in patients with coronary artery disease; therefore, an angiography-guided evaluation could under- or over-estimate lesion severity in specific lesion subsets. |
| Author | Koo, Bon-Kwon Cho, Hyun-Ok Chung, In-Sung Park, Hyoung-Seob Nam, Chang-Wook Hyun, Dae-Woo Kim, Yoon-Nyun Cho, Yun-Kyeong Kim, Hyungseop Doh, Joon-Hyung Yoon, Hyuck-Jun Hur, Seung-Ho Kim, Kwon-Bae |
| AuthorAffiliation | 2 Andong Medical Group, Cardiovascular Center, Andong, Korea 3 Department of Occupational and Environmental Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea 4 Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea 5 Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea 1 Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea |
| AuthorAffiliation_xml | – name: 3 Department of Occupational and Environmental Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea – name: 5 Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea – name: 4 Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea – name: 1 Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea – name: 2 Andong Medical Group, Cardiovascular Center, Andong, Korea |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25469141$$D View this record in MEDLINE/PubMed https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001928595$$DAccess content in National Research Foundation of Korea (NRF) |
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| Keywords | Coronary angiography Coronary artery disease Fractional flow reserve, myocardial |
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| Snippet | Coronary lesions with mismatched functional and anatomical significance are not uncommon. We assessed the accuracy and predictors of mismatch between... Background and Objectives: Coronary lesions with mismatched functional and anatomical significance are not uncommon. We assessed the accuracy and predictors of... |
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| Title | Characteristics of Function-Anatomy Mismatch in Patients with Coronary Artery Disease |
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