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Combined use of hyperemic and non-hyperemic pressure ratios for revascularization decision-making: From the ILIAS
Coen K M Boerhout1, Guus A de Waard1, Joo Myung Lee2
1Heart Center, Amsterdam UMC, Amsterdam, The Netherlands.
Insights
Non-hyperemic Pd/Pa offers prognostic value for coronary artery disease, similar to FFR. Combining both pressure ratios can guide revascularization decisions, improving patient outcomes.
Area of Science:
- Cardiovascular physiology
- Interventional cardiology
- Diagnostic imaging
Background:
- Coronary artery disease assessment relies on pressure ratios.
- Non-hyperemic Pd/Pa is a potential diagnostic tool.
- The ILIAS Registry (NCT04485234) provided data for this study.
Purpose of the Study:
- Evaluate the diagnostic and prognostic value of non-hyperemic Pd/Pa.
- Assess the added benefit of combining non-hyperemic Pd/Pa with FFR.
- Guide revascularization decisions in coronary artery disease.
Main Methods:
- Retrospective analysis of 2726 vessels from 2141 patients in a multi-center registry.
- Classification based on FFR (≤0.80) and non-hyperemic Pd/Pa (≤0.92) values.
- Primary outcome: target-vessel failure (TVF) at 5-year follow-up.
Main Results:
- Good correlation between FFR and non-hyperemic Pd/Pa (r=0.73), with 17% discordance.
- Resting Pd/Pa independently predicted TVF (HR 0.08, p<0.005).
- Highest TVF risk in vessels with any abnormal pressure ratio where revascularization was deferred.
Conclusions:
- Abnormal non-hyperemic and hyperemic pressure ratios have significant prognostic value.
- Combined FFR and non-hyperemic Pd/Pa identify vessels with excellent long-term outcomes.
- Revascularization decisions may benefit from integrated non-hyperemic and hyperemic pressure ratio assessment.
Objective:
The aim of this study is to evaluate the diagnostic and prognostic value of non-hyperaemic Pd/Pa and to determine its additional value when combined with the gold standard hyperaemic pressure ratio (FFR) to guide revascularization.
Methods:
In a large, multi-center, retrospective registry, we included a total of 2141 patients with a clinical indication for coronary angiography providing physiological data in 2726 vessels. A classification was made based on the FFR (cut-off value: 0.80) and non-hyperaemic Pd/Pa (cut-off value: 0.92) values and the primary outcome was target-vessel failure (TVF) at 5-year follow-up.
Results:
Mean age was 63 ± 10.0 and 75% of the study population were men. Regression analysis showed an overall good correlation between FFR and non-hyperaemic Pd/Pa (r = 0.73, p < 0.005) and discordance was present in 17% of the vessels. Resting Pd/Pa was independently associated with TVF at 5-year follow-up (HR 0.08, 95%CI: 0.02-0.27; p < 0.005). The risk for TVF was the lowest in vessles with concordant normal pressure ratio's, with the highest risk in vessels with any abnormal pressure ratio in which revascularization was deferred. In these vessels, there was no difference in risk for TVF between the discordant and concordant abnormal values.
Conclusion:
Abnormal pressure ratios in both non-hyperemic and hyperemic conditions portend important prognostic value. Combined application of FFR and non-hyperemic Pd/Pa efficiently identifies those vessels with concordant normal resting and hyperemic pressure ratios of which long-term clinical outcomes are excellent. These data lead to hypothesize that the decision to defer revascularization should potentially be based on combined non-hyperemic and hyperemic pressure ratios.
Clinical Trial Registration:
Inclusive Invasive Physiological Assessment in Angina Syndromes Registry (ILIAS Registry), NCT04485234.
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