Visual-functional mismatch between coronary angiography and fractional flow reserve.
OBJECTIVE
The goal of this study was to identify clinical and lesion-specific local factors affecting visual-functional mismatch.


BACKGROUND
Although lesion severity determined by coronary angiography has not been well correlated with physiological significance, the mechanism of the discordance remains poorly understood.


METHODS
The authors assessed quantitative coronary angiography, intravascular ultrasound (IVUS), and fractional flow reserve (FFR) in a prospective cohort of 1,000 patients with 1,129 coronary lesions. Three-dimensional computational simulation studies were performed.


RESULTS
Lesions with angiographic diameter stenosis (DS) ≥50% and FFR >0.80 ("mismatches") were seen in 57% of non-left main lesions and in 35% of the left main lesions, respectively (p = 0.032). Conversely, among the lesions with DS <50% and FFR <0.80 ("reverse mismatches") 16% were found in the non-left main lesions and 40% in the left main lesions (p < 0.001). The independent predictors for mismatch were advanced age, non-left anterior descending artery location, absence of plaque rupture, short lesion length, large minimal lumen area, smaller plaque burden, and greater minimal lumen diameter. Conversely, reverse mismatch was independently associated with younger age, left anterior descending artery location, the presence of plaque rupture, a smaller minimal lumen area, and larger plaque burden. In a computational simulation study, FFR was influenced by DS, lesion length, different lesion shape, plaque eccentricity, surface roughness, and various shapes of plaque rupture.


CONCLUSIONS
There were high frequencies of visual-functional mismatch between angiography and FFR. The discrepancy was related to the clinical and lesion-specific factors frequently unrecognizable by angiography, thus suggesting that coronary angiography cannot accurately predict FFR. (Natural History of FFR-Guided Deferred Coronary Lesions [IRIS FFR-DEFER]; NCT01366404).
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. sjpark@amc.seoul.kr
Seung-Jung
SJ
Park
Soo-Jin
SJ
Kang
Jung-Min
JM
Ahn
Eun Bo
EB
Shim
Young-Tae
YT
Kim
Sung-Cheol
SC
Yun
Haegeun
H
Song
Jong-Young
JY
Lee
Won-Jang
WJ
Kim
Duk-Woo
DW
Park
Seung-Whan
SW
Lee
Young-Hak
YH
Kim
Cheol Whan
CW
Lee
Gary S
GS
Mintz
Seong-Wook
SW
Park
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003198:Computer Simulation; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D013223:Statistics as Topic