title: Clinical usefulness of nonhyperemic baseline Pd/Pa as a hybrid baseline Pd/Pa-fractional flow reserve strategy.
abstract: OBJECTIVE
  The ratio of basal distal intracoronary pressure (Pd) and aortic pressure (Pa) is a nonhyperemic index for the severity of coronary artery stenosis. The aim of the current study was to evaluate the clinical usefulness of a hybrid baseline Pd/Pa-fractional flow reserve (FFR) strategy in reducing the need for hyperemia.
  
  
  METHODS
  In this study, 570 lesions from 527 consecutive patients who had both baseline Pd/Pa and FFR determined were evaluated retrospectively. To evaluate the hybrid baseline Pd/Pa-FFR approach, patients were categorized into treatment, deferral, and undetermined groups on the basis of their baseline Pd/Pa. Thereafter, patients in the undetermined group were assigned to FFR-guided treatment or deferral on the basis of an FFR cutoff value of 0.80 or lower. Major adverse cardiac events were evaluated in a median of 48.8 months (interquartile range, 35.0-66.4).
  
  
  RESULTS
  A hybrid strategy using a deferral baseline Pd/Pa value of 1.00 (negative predictive value of 100%) and a treatment baseline Pd/Pa value of 0.86 or lower (positive predictive value of 100%), and limiting adenosine to a baseline Pd/Pa value between 0.87 and 0.99 would prevent the need for vasodilator drugs in 14.6% of lesions (14.0% patients), maintaining 100% agreement with an FFR-only strategy. However, adenosine-free lesions are increased to 59.6%, with 91% agreement. There was no difference in the major adverse cardiac event-free survival rate at 5 years between baseline Pd/Pa-guided and FFR-guided treatment patients (70.8 vs. 76.3%, P=0.63), or between baseline Pd/Pa-guided and FFR-guided deferral patients (71.3 vs. 82.4%, P=0.99).
  
  
  CONCLUSIONS
  The current study reports a range of baseline Pd/Pa values that can predict myocardial ischemia without the need for inducing hyperemia. Adoption of this hybrid baseline Pd/Pa-FFR approach can reduce the need for drug-induced hyperemia.
authors.affiliation: aDepartment of Internal Medicine, Division of Cardiovascular Diseases bBiomedical Statistics cDivision of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA dDivision of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China.
authors.forename: Taek-Geun
authors.initials: TG
authors.lastname: Kwon
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsuzawa
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Aoki
authors.forename: Raviteja R
authors.initials: RR
authors.lastname: Guddeti
authors.forename: R Jay
authors.initials: RJ
authors.lastname: Widmer
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Cilluffo
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000241:Adenosine; D000368:Aged; D001011:Aorta / Q000503:physiopathology; D062186:Arterial Pressure; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine