Abstract 12865: Predictors of “Visual-Functional Mismatch” in Contemporary Practice -The Lesion Characteristics Associating With Mismatch Between Angiographic Stenosis and Fractional Flow Reserve

Abstract

Background: The benefit of fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) in patients with coronary artery disease compared with angio-guided PCI has shown recently. However, the argument for mismatch (angiographic diameter stenosis ≧ 50% and FFR > 0.80) or reverse-mismatch (angiographic diameter stenosis < 50%, FFR ≦ 0.80), so called, “visual-functional mismatch”, is remains to be solved in contemporary practice. In the present study, we examined the association of the lesion characteristics and “visual-functional mismatch”. Method and Results: We analyzed 140 consecutive patients (157 lesions) undergoing coronary angiography and FFR examination. The mean age of study population was 68.7 years old, 54.3% of them had diabetes, 87.9% of them had hypertension and 77.1% of them had dyslipidemia. In terms of lesion characteristics, ratio of LAD lesion was 58.6%, tandem or diffuse lesion was 48.4%, mean percentage of diameter stenosis was 68.2% and lesion length was 16.3mm. The study population was divided into 4 groups by angiographic stenosis (cut-off: 50%) and FFR (cut-off: 0.80). There were no differences in patients’ background among 4 groups. Mismatches were observed in 28.7% of lesions, whereas, reverse-mismatches were observed in 10.1% of lesions. Lesion characteristics causing “visual-functional mismatch” are shown in Table 1 and ROC curve s of diameter stenosis for functional significance are shown in Figure 1. Conclusion: Specific lesion characteristics are applicable for predicting “visual-functional mismatch”. Angiographic severity seemed to be more reliable in LAD lesions, tandem/diffuse lesions or proximal lesions. FFR measurement should be considered for angiographic 50% stenosis in LAD to perform appropriate PCI, whereas, FFR measurement should be considered for angiographic 75% stenosis in non-LAD to avoid unnecessary PCI.