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Multicenter Study
. 2022 May 23;15(10):1047-1056.
doi: 10.1016/j.jcin.2022.03.016.

Combined Assessment of FFR and CFR for Decision Making in Coronary Revascularization: From the Multicenter International ILIAS Registry

Tim P van de Hoef  1 , Joo Myung Lee  2 , Coen K M Boerhout  3 , Guus A de Waard  4 , Ji-Hyun Jung  5 , Seung Hun Lee  6 , Hernán Mejía-Rentería  7 , Masahiro Hoshino  8 , Mauro Echavarria-Pinto  9 , Martijn Meuwissen  10 , Hitoshi Matsuo  11 , Maribel Madera-Cambero  12 , Ashkan Eftekhari  13 , Mohamed A Effat  14 , Tadashi Murai  8 , Koen Marques  4 , Joon-Hyung Doh  15 , Evald H Christiansen  13 , Rupak Banerjee  16 , Chang-Wook Nam  17 , Giampaolo Niccoli  18 , Masafumi Nakayama  19 , Nobuhiro Tanaka  20 , Eun-Seok Shin  21 , Niels van Royen  22 , Steven A J Chamuleau  23 , Paul Knaapen  4 , Javier Escaned  7 , Tsunekazu Kakuta  8 , Bon Kwon Koo  24 , Jan J Piek  3
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Free article
Multicenter Study

Combined Assessment of FFR and CFR for Decision Making in Coronary Revascularization: From the Multicenter International ILIAS Registry

Tim P van de Hoef et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The aim of this study was to demonstrate the clinical implications of combined assessment of fractional flow reserve (FFR) and coronary flow reserve (CFR).

Background: Combined assessment of FFR and CFR allows detailed characterization of pathophysiology in chronic coronary syndromes. Data on the clinical implications of distinct FFR and CFR patterns are limited, leading to uncertainty regarding their relevance.

Methods: Patients with chronic coronary syndromes and obstructive coronary artery disease were selected from the multicenter ILIAS (Inclusive Invasive Physiological Assessment in Angina Syndromes) registry. Patients were classified into 4 groups on the basis of FFR ≤0.80 and CFR <2.0. The endpoint was the 5-year target vessel failure (TVF) rate.

Results: A total of 2,143 patients with 2,725 lesions were included. Compared with normal FFR/normal CFR, low FFR/low CFR carried the highest risk for TVF (HR: 5.4; 95% CI: 3.2-9.3; P < 0.001), significantly higher than in revascularized vessels (P = 0.007). Discordance, with either low FFR/normal CFR or normal FFR/low CFR, was associated with increased TVF rates compared with normal FFR/normal CFR (low FFR/normal CFR: HR: 3.5 [95% CI: 2.2-5.4; P < 0.001]; normal FFR/low CFR: HR: 3.0 [95% CI: 1.9-4.7; P < 0.001]). No difference in 5-year TVF was observed between the 2 discordant groups (P = 0.57) or between the discordant groups and the revascularized group (P = 0.26 vs low FFR/normal CFR; P = 0.60 vs normal FFR/low CFR).

Conclusions: Impaired coronary hemodynamics are uniformly associated with increased 5-year TVF rates. Nonrevascularized vessels with discordant FFR and CFR are associated with 5-year event rates that are equivalent to those of vessels that undergo revascularization, whereas vessels with combined low FFR and CFR exhibit event rates that are significantly higher than after revascularization. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry]; NCT04485234).

Keywords: coronary flow reserve; fractional flow reserve; percutaneous coronary intervention.

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Conflict of interest statement

Funding Support and Author Disclosures Dr van de Hoef has received speaker fees and institutional research grants from Abbott and Philips. Dr J.M. Lee has received research grants from Abbott and Philips. Dr Echavarria-Pinto has received speaker fees from Abbott and Philips. Dr van Royen has received speaker fees and institutional research grants from Abbott and Philips. Dr Escaned is a speaker and consultant for Abbott, Boston Scientific, and Philips; and has received personal fees from Philips, Boston Scientific, and Abbott/St. Jude Medical outside the submitted work. Dr Koo has received institutional research grants from Abbott Vascular and Philips Volcano. Dr Piek has received support as a consultant for Philips/Volcano; and has received institutional research grants from Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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