Related Experiment Video
Updated: Jun 29, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
What is the angiography error when defining myocardial ischemia during percutaneous coronary interventions?
Fernando Mendes Sant'Anna1, Expedito Ribeiro da Silva, Leonardo Alves Batista
1Santa Helena Hospital do Coração, Cabo Frio, RJ, Brasil. fernandomendes@cardiol.br
Insights
Angiography alone is inaccurate for assessing coronary artery disease (CAD) severity, especially for intermediate lesions. Functional evaluation using fractional flow reserve (FFR) is crucial for accurate diagnosis and treatment of CAD.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) diagnosis traditionally relies on angiography, despite known limitations.
- Myocardial fractional flow reserve (FFR) is an established functional assessment for CAD.
Purpose of the Study:
- To evaluate the diagnostic accuracy of angiography in defining ischemic lesions.
- To assess the correlation between angiography and FFR in patients with CAD.
Main Methods:
- 250 patients with 471 arteries were analyzed.
- Stenoses >= 50% by visual estimate underwent FFR measurement.
- Quantitative coronary angiography (QCA) and visual assessment (VA) were compared with FFR.
Main Results:
- FFR was obtainable in 96% of lesions.
- Concordance between QCA and FFR was poor, particularly for intermediate stenoses (Spearman's rho = -0.33).
- Angiography visual assessment accuracy was 57% for intermediate and 96% for severe lesions.
Conclusions:
- Neither visual angiography nor QCA accurately predicts the significance of intermediate coronary stenoses.
- Functional assessment with FFR is essential for appropriate treatment of coronary stenoses.
- Integrating FFR improves the management of coronary artery disease.
Background:
The angiography has been used as a reference standard to define coronary artery disease (CAD), although its limitations are well-known. The significance of the myocardial fractional flow reserve (FFR) in the assessment of CAD is well established.
Objective:
The aim of this study was to evaluate the accuracy of angiography when defining ischemic lesions and its correlation with FFR.
Methods:
Two hundred and fifty consecutive patients (471 arteries) were included in this study. All stenoses >or= 50% at the angiography visual estimate (AVE) were assessed by FFR measurements. When FFR was < 0.75, stenting was performed; when FFR was >or= 0.75, no interventional treatment was carried out. Offline quantitative coronary angiography (QCA) was performed in all stenoses, which were divided in intermediate (< 70% - 327) and severe (125). The correlation coefficients between the diameter of the stenosis (%DS) and FFR and the accuracy of VA of the angiography when assessing ischemia were determined.
Results:
FFR could be obtained in 452 lesions (96%). Mean %DS and FFR were 56 +/- 8% and 0.74 and 76 +/- 6% and 0.48 for moderate and severe stenoses, respectively. Concordance between QCA and FFR was poor, especially in intermediate stenoses (Spearman's rho = - 0.33, p<0.0001). Visual assessment resulted in an accuracy of 57% and 96% in intermediate and severe lesions, respectively.
Conclusion:
Neither the visual assessment of an angiogram nor QCA can accurately predict the significance of most intermediate coronary stenoses, which emphasizes the importance of associating it to a functional evaluation of the coronary circulation, resulting in an adequate treatment of these stenoses.
More Related Videos
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:30Angina I: Introduction
01:30Acute Coronary Syndrome I: Introduction
01:27Angina II: Classification
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:21Cardiac Catheterization II: Right Heart Catheterization