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Lesion characteristics of coronary arteries associated with a mismatch between angiographic severity of stenosis and fractional flow reserve

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Abstract

We aimed to clarify the relationships between angiographic lesion characteristics and values of fractional flow reserve (FFR) on intermediate coronary artery stenosis. The clinical meaning and assessment for “visual-functional mismatches,” including regular-mismatches [defined as angiographic percent diameter stenosis (%DS) ≥50 % and FFR >0.80] and reverse-mismatches (defined as angiographic %DS <50 %, FFR ≤0.80) remains unresolved in contemporary practice. We retrospectively enrolled 140 consecutive patients who underwent coronary angiography and FFR measurement. One hundred fifty-seven cases of intermediate coronary artery stenosis were evaluated. The relationship between clinical/lesion characteristics and regular- or reverse-mismatches were examined. Lesions in the left anterior descending artery (LAD) showed significantly lower frequency of regular-mismatch than did non-LAD lesions (26.7 vs. 73.3 %, respectively; p < 0.001). Conversely, almost all reverse-mismatches were observed in LAD lesions (93.8 %). The best cut-off value of %DS, derived from receiver operating characteristic (ROC) curve analysis, to predict FFR ≤0.8 was 45.0 % in LAD lesions and 67.5 % in non-LAD lesions. FFR measurement should be considered in LAD intermediate lesions to avoid residual functional ischemia and in non-LAD lesions to avoid unnecessary coronary intervention.

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This study was not financially supported from any company, grant, or fund.

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Correspondence to Junichi Yamaguchi.

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Arashi, H., Yamaguchi, J., Nakazawa, M. et al. Lesion characteristics of coronary arteries associated with a mismatch between angiographic severity of stenosis and fractional flow reserve. Cardiovasc Interv and Ther 32, 120–126 (2017). https://doi.org/10.1007/s12928-016-0399-8

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