title: Severity of morphological lesion complexity affects fractional flow reserve in intermediate coronary stenosis.
abstract: BACKGROUND
  Although functional ischemia identification is important when determining revascularization, angiographic assessment alone is challenging in intermediate coronary stenosis. Previous studies have reported that lesion-specific characteristics affected the fractional flow reserve (FFR). However, the relationship between morphological lesion complexity and FFR has not yet been fully evaluated. This study aimed to evaluate the impact of morphological lesion complexity on FFR in intermediate coronary stenosis.
  
  
  METHODS
  A total of 109 consecutive patients with 136 intermediate coronary stenoses (visually estimated diameter stenosis: 40-70%) were assessed via quantitative coronary angiography, lesion-specific characteristics, and FFR. Indexed lesions were assessed according to 6 morphological lesion characteristics: eccentricity, bend, irregularity, calcification, bifurcation, and diffuse. The lesions were then classified into 3 groups according to the morphological severity count represented by the number of present characteristics (mild-complex: 0-1, moderate-complex: 2-3, and severe-complex: 4-6), and their functional severities were evaluated. Lesions with an FFR <0.80 were considered functionally significant coronary stenoses.
  
  
  RESULTS
  Of the 136 lesions, 51% were located in the left anterior descending artery (LAD) and 47% had an FFR <0.80. The FFR differed significantly among the 3 lesion complexity groups (0.84±0.10 vs. 0.79±0.10 vs. 0.73±0.07, for mild-, moderate-, and severe-complex, respectively; p<0.01). In a multivariate logistic analysis, LAD lesions, moderate- and severe-complex, and diameter stenosis were independently associated with an FFR <0.80 [odds ratio (OR): 5.65, 95% confidence interval (CI): 2.50-12.80, p<0.01; OR: 2.96, 95% CI: 1.30-6.72, p<0.01; OR: 7.11, 95% CI: 1.25-40.37, p=0.03, and OR: 2.65, 95% CI: 1.04-6.72, p=0.04, respectively].
  
  
  CONCLUSIONS
  Both indexed vessels and the degree of diameter stenosis affected the FFR. In addition, the severity of morphological lesion complexity correlated with the degree of functional severity in intermediate coronary stenosis.
authors.affiliation: Department of Cardiology, Aichi Medical University, Aichi, Japan. Electronic address: h0914@aichi-med-u.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takashima
authors.affiliation: Department of Cardiology, Aichi Medical University, Aichi, Japan.
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Waseda
authors.affiliation: Advanced Medical Research Center, Aichi Medical University, Aichi, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Gosho
authors.affiliation: Department of Cardiology, Aichi Medical University, Aichi, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kurita
authors.affiliation: Department of Cardiology, Aichi Medical University, Aichi, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Ando
authors.affiliation: Department of Cardiology, Aichi Medical University, Aichi, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Sakurai
authors.affiliation: Department of Cardiology, Aichi Medical University, Aichi, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Department of Cardiology, Aichi Medical University, Aichi, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kumagai
authors.affiliation: Department of Cardiology, Aichi Medical University, Aichi, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Aichi Medical University, Aichi, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Amano
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Coronary angiography; Coronary artery disease; Fractional flow reserve; Lesion complexity