Document Detail

Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry.
MedLine Citation:
PMID:  22917666     Owner:  NLM     Status:  MEDLINE    
AIMS: To evaluate the classification agreement between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with angiographic intermediate coronary stenoses.
METHODS AND RESULTS: Three hundred and twelve patients (339 stenoses) with angiographically intermediate stenoses were included in this international clinical registry. The iFR was calculated using fully automated algorithms. The receiver operating characteristic (ROC) curve was used to identify the iFR optimal cut-point corresponding to FFR 0.8. The classification agreement of coronary stenoses as significant or non-significant was established between iFR and FFR and between repeated FFR measurements for each 0.05 quantile of FFR values, from 0.2 to 1. Close agreement was observed between iFR and FFR (area under ROC curve= 86%). The optimal iFR cut-off (for an FFR of 0.80) was 0.89. After adjustment for the intrinsic variability of FFR, the classification agreement (accuracy) between iFR and FFR was 94%. Amongst the stenoses classified as non-significant by iFR (>0.89) and as significant by FFR (≤0.8), 81% had associated FFR values located within the FFR "grey-zone" (0.75-0.8) and 41% within the 0.79-0.80 FFR range.
CONCLUSIONS: In a population of intermediate coronary stenoses, the classification agreement between iFR and FFR is excellent and similar to that of repeated FFR measurements in the same sample. Vasodilator-independent assessment of intermediate stenosis seems applicable and may foster adoption of coronary physiology in the catheterisation laboratory.
Ricardo Petraco; Javier Escaned; Sayan Sen; Sukhjinder Nijjer; Kaleab N Asrress; Mauro Echavarria-Pinto; Tim Lockie; Muhammed Z Khawaja; Cecilia Cuevas; Nicolas Foin; Christopher Broyd; Rodney A Foale; Nearchos Hadjiloizou; Iqbal S Malik; Ghada W Mikhail; Amarjit Sethi; Raffi Kaprielian; Christopher S Baker; David Lefroy; Michael Bellamy; Mahmud Al-Bustami; Masood A Khan; Alun D Hughes; Darrel P Francis; Jamil Mayet; Carlo Di Mario; Simon Redwood; Justin E Davies
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology     Volume:  9     ISSN:  1969-6213     ISO Abbreviation:  EuroIntervention     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-05-20     Completed Date:  2013-12-23     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  101251040     Medline TA:  EuroIntervention     Country:  France    
Other Details:
Languages:  eng     Pagination:  91-101     Citation Subset:  IM    
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MeSH Terms
Cardiac Catheterization
Coronary Angiography
Coronary Stenosis / classification,  diagnosis*,  physiopathology,  radiography
Coronary Vessels / physiopathology*,  radiography
Fractional Flow Reserve, Myocardial*
Middle Aged
Predictive Value of Tests
ROC Curve
Reproducibility of Results
Severity of Illness Index
Grant Support
FS/10/38/28268//British Heart Foundation; FS/11/43/28760//British Heart Foundation; FS/11/46/28861//British Heart Foundation; G1000357//Medical Research Council; G1100443//Medical Research Council
Comment In:
EuroIntervention. 2013 Oct;9(6):769-70   [PMID:  24169141 ]
EuroIntervention. 2013 Oct;9(6):770-2   [PMID:  24344413 ]
EuroIntervention. 2013 May 20;9(1):167-8   [PMID:  23828955 ]
EuroIntervention. 2013 May 20;9(1):166-7   [PMID:  23685307 ]
EuroIntervention. 2013 May 20;9(1):11-3   [PMID:  23685289 ]

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