Abstract
BackgroundThe current pressure-based coronary diagnostic index, fractional flow reserve (FFR), has a limited efficacy in the presence of microvascular disease (MVD). To overcome the limitations of FFR, the objective is to assess the recently introduced pressure drop coefficient (CDP), a fundamental fluid dynamics-based combined pressure–flow index.MethodsWe hypothesize that CDP will result in improved clinical outcomes in comparison to FFR. To test the hypothesis, chi-square test was performed to compare the percent major adverse cardiac events (%MACE) at 5 years between (a) FFR < 0.75 and CDP > 27.9 and (b) FFR < 0.80 and CDP > 25.4 groups using a prospective cohort study. Furthermore, Kaplan–Meier survival curves were compared between the FFR and CDP groups. The results were considered statistically significant for p < 0.05. The outcomes of the CDP arm were presumptive as clinical decision was solely based on the FFR.ResultsFor the complete patient group, the %MACE in the CDP > 27.9 group (10 out of 35, 29%) was lower in comparison to the FFR < 0.75 group (11 out of 20, 55%), and the difference was near significant (p = 0.05). The survival analysis showed a significantly higher survival rate (p = 0.01) in the CDP > 27.9 group (n = 35) when compared to the FFR < 0.75 group (n = 20). The results remained similar for the FFR = 0.80 cutoff. The comparison of the 5-year MACE outcomes with the 1-year outcomes for the complete patient group showed similar trends, with a higher statistical significance for a longer follow-up period of 5 years.ConclusionBased on the MACE and survival analysis outcomes, CDP could possibly be an alternate diagnostic index for decision-making in the cardiac catheterization laboratory.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT01719016.
Highlights
The impediment of blood flow to the heart muscle results from the sum of epicardial stenosis resistance and microvascular disease (MVD) resistance, which act in series (Pijls et al, 1993; Chilian, 1997; Kern, 2000; Fearon, 2004; Siebes et al, 2004)
The results remained similar for the fractional flow reserve (FFR) = 0.80 cutoff
The impediment of blood flow to the heart muscle results from the sum of epicardial stenosis resistance and microvascular disease (MVD) resistance, which act in series (Pijls et al, 1993; Chilian, 1997; Kern, 2000; Fearon, 2004; Siebes et al, 2004)
Summary
The impediment of blood flow to the heart muscle results from the sum of epicardial stenosis resistance and microvascular disease (MVD) resistance, which act in series (Pijls et al, 1993; Chilian, 1997; Kern, 2000; Fearon, 2004; Siebes et al, 2004). Delineation of the relative contributions of these resistances is vital, as they should be used to guide the clinical decision-making for the selection of the most appropriate treatments (Fearon, 2003; Verna et al, 2006) Diagnostic parameters such as fractional flow reserve (FFR, the ratio of the mean distal coronary and aortic pressure at hyperemia) and coronary flow reserve (CFR; the ratio of coronary flow at hyperemia to that at rest) are often used for the functional (hemodynamic) evaluation of stenosis in current clinical practice (Kern et al, 2006; Smith et al, 2006; Wijns and Kolh, 2010). The current pressure-based coronary diagnostic index, fractional flow reserve (FFR), has a limited efficacy in the presence of microvascular disease (MVD). To overcome the limitations of FFR, the objective is to assess the recently introduced pressure drop coefficient (CDP), a fundamental fluid dynamics-based combined pressure–flow index
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