title: Clinical and angiographic predictors of haemodynamically significant angiographic lesions: development and validation of a risk score to predict positive fractional flow reserve.
abstract: OBJECTIVE
  Coronary revascularisation based upon physiological evaluation of lesions improves clinical outcomes. Angiographic or visual stenosis assessment alone is insufficient in predicting haemodynamic stenosis severity by fractional flow reserve (FFR) and therefore cannot be used to guide revascularisation, particularly in the lesion subset <70%. Accordingly, we sought to identify independent determinants of angiographic intermediate lesions with haemodynamic significance.
  
  
  RESULTS
  We assessed consecutive intermediate lesions for patients from January 2014 to April 2015 at our institution. Independent predictors of FFR positivity (FFR ≤0.8) were identified and a scoring system formulated. Of 1,023 consecutive lesions (883 patients), 314 (31%) were haemodynamically significant. Characteristics associated with FFR ≤0.8 include male gender, higher SYNTAX score, lesions ≥20 mm, stenosis >50%, bifurcation, calcification, absence of tortuosity and smaller reference diameter. A user-friendly integer score was developed with the five variables demonstrating the strongest association. On prospective validation (in 279 distinct lesions), the increasing value of the score correlated well with increasing haemodynamic significance (C-statistic 0.85).
  
  
  CONCLUSIONS
  We identified several clinical and angiographic characteristics and formulated a scoring system to guide the approach to intermediate lesions. This may translate into cost savings. Larger studies with prospective validation are required to confirm our results.
authors.affiliation: Department of Cardiology, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Nishtha
authors.initials: N
authors.lastname: Sareen
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.forename: Safwan
authors.initials: S
authors.lastname: Kezbor
authors.forename: Sonny
authors.initials: S
authors.lastname: Sayseng
authors.forename: Melissa
authors.initials: M
authors.lastname: Aquino
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Joseph
authors.initials: J
authors.lastname: Sweeny
authors.forename: Nitin
authors.initials: N
authors.lastname: Barman
authors.forename: Annapoorna
authors.initials: A
authors.lastname: Kini
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk