J Cardiovasc Interv.  2022 Oct;1(4):158-167. 10.54912/jci.2022.0013.

Factors Associated With Discrepancy of FFR-Based Lesion Classification Between Intracoronary Bolus and Intravenous Infusion of Adenosine

• Kwon TG
• Matsuzawa Y
• Gulati R
• Lennon RJ
• Lerman LO
• Lerman A

• KMID: 2561255
• DOI: http://doi.org/10.54912/jci.2022.0013

Abstract

Background
The prerequisite for fractional flow reserve (FFR) measurement is the induction of maximal hyperemia, mostly with intracoronary (IC) or intravenous (IV) adenosine administration. However, FFR-based lesion classification can differ depending on the method of vasodilator administration. In this study, we hypothesized that discrepancies in FFR-based lesion classification are related to specific pathophysiological conditions.
Methods
A total of 56 patients (56 lesions) who underwent coronary angiography for chest pain along with FFR measured by both IC (24–72 μg for right, 36–120 μg for left) and IV (140 μg/ kg/min) adenosine was evaluated. In the current study, FFR measured by these 2 methods had a good correlation (Spearman’s ρ = 0.70; 95% confidence interval [CI], 0.47–0.78; P < 0.001).
Results
Among 47 lesions with FFR > 0.80 by IC adenosine, 38 lesions showed agreement and 9 lesions showed discrepancy in lesion classification as compared with FFR measurement by IV adenosine. In univariate analysis, tandem lesion (odds ratio [OR], 10.7; 95% CI, 2.2–63.3; P = 0.003) and a history of cerebrovascular events (OR, 6.8; 95% CI, 1.3– 38.9; P = 0.025) were significantly associated with discrepant FFR-based lesion classification. Multivariate regression analysis demonstrated that tandem lesion (OR, 12.0; 95% CI, 2.2–96.6; P = 0.004) and history of cerebrovascular events (OR, 8.0; 95% CI, 1.1–74.8; P = 0.037) were independently associated with discrepant classification.
Conclusions
A careful and comprehensive approach may be required to evaluate coronary stenosis with FFR using adenosine in patients with tandem lesions or with a history of cerebrovascular events.

Keyword

Adenosine; Coronary disease; Myocardial fractional flow reserve