Long‐Term Clinical Outcomes of Nonhyperemic Pressure Ratios: Resting Full‐Cycle Ratio, Diastolic Pressure Ratio, and Instantaneous Wave‐Free Ratio
Open Access
- 15 September 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Heart Association
- Vol. 9 (18)
- https://doi.org/10.1161/jaha.120.016818
Abstract
Background Nonhyperemic pressure ratios (NHPRs) such as instantaneous wave‐free ratio, resting full‐cycle ratio, or diastolic pressure ratio have emerged as invasive physiologic indices precluding the need for hyperemic agents. The current study sought to evaluate the long‐term prognostic implications of NHPRs compared with fractional flow reserve (FFR). Methods and Results NHPRs were calculated from resting pressure tracings by an independent core laboratory in 1024 vessels (435 patients). The association between NHPRs and the risk of 5‐year vessel‐oriented composite outcomes (VOCO, a composite of cardiac death, vessel‐related myocardial infarction, and ischemia‐driven revascularization) were analyzed among 864 deferred vessels. Lesions with positive NHPRs (instantaneous wave free ratio, resting full‐cycle ratio, and diastolic pressure ratio ≤0.89) or FFR (≤0.80) showed significantly higher risk of VOCO at 5 years than those with negative NHPRs or FFR, respectively. Discriminant ability for 5‐year VOCO was not different among NHPRs and FFR (C‐index: 0.623–0.641, P for comparison=0.215). In comparison of VOCO among the groups with deferred concordant negative (NHPRs−/FFR−), deferred discordant (NHPRs+/FFR− or NHPRs−/FFR+), and revascularized vessels, the cumulative incidence of VOCO were 7.5%, 14.4%, and 14.8% (log‐rank PP=0.964). Conclusions Currently available invasive pressure‐derived indices showed similar prognostic implications for vessel‐related events at 5 years. Deferred lesions with discordant results between NHPRs and FFR did not show higher risk of vessel‐related events at 5 years than revascularized vessels. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01621438, NCT01621438.This publication has 26 references indexed in Scilit:
- Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCIThe New England Journal of Medicine, 2017
- Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCIThe New England Journal of Medicine, 2017
- Diagnostic Performance of Resting and Hyperemic Invasive Physiological Indices to Define Myocardial IschemiaJACC: Cardiovascular Interventions, 2017
- Integrated Myocardial Perfusion Imaging Diagnostics Improve Detection of Functionally Significant Coronary Artery Stenosis by 13 N-ammonia Positron Emission TomographyCirculation: Cardiovascular Imaging, 2016
- Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trialThe Lancet, 2015
- Coronary pressure and flow relationships in humans: phasic analysis of normal and pathological vessels and the implications for stenosis assessment: a report from the Iberian–Dutch–English (IDEAL) collaboratorsEuropean Heart Journal, 2015
- Fractional Flow Reserve–Guided PCI for Stable Coronary Artery DiseaseThe New England Journal of Medicine, 2014
- Development and Validation of a New Adenosine-Independent Index of Stenosis Severity From Coronary Wave-Intensity Analysis Results of the ADVISE (ADenosine Vasodilator Independent Stenosis Evaluation) StudyJournal of the American College of Cardiology, 2012
- Low Diagnostic Yield of Elective Coronary AngiographyThe New England Journal of Medicine, 2010
- Inference in Spline‐Based Models for Multiple Time‐to‐Event Data, with Applications to a Breast Cancer Prevention TrialBiometrics, 2003