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Agreement of Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience

Background Coronary physiological is recommended in contemporary guidelines to measure non flow limiting stenosis in patients with stable coronary artery disease (CAD). Application of computational fluid dynamics to derive fractional flow reserve (FFR) eliminates the potential complications associ...

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Main Authors: Chow, Han Bing, Chandan, Bhavnani, Ho, Kian Hui, Ting, Tan Chen, Francis, Shu, Koh, Keng Tat, Oon, Yen Yee, Asri, Said, Alan, Fong, Ong, Tiong Kiam
Format: Article
Language:English
Published: Elsevier 2023
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RC Internal medicine
Online Access:http://ir.unimas.my/id/eprint/43922/4/chow.pdf
http://ir.unimas.my/id/eprint/43922/
https://www.jacc.org/doi/full/10.1016/j.jacc.2023.03.090
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spelling my.unimas.ir.439222023-12-28T06:48:03Z http://ir.unimas.my/id/eprint/43922/ Agreement of Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience Chow, Han Bing Chandan, Bhavnani Ho, Kian Hui Ting, Tan Chen Francis, Shu Koh, Keng Tat Oon, Yen Yee Asri, Said Alan, Fong Ong, Tiong Kiam RC Internal medicine Background Coronary physiological is recommended in contemporary guidelines to measure non flow limiting stenosis in patients with stable coronary artery disease (CAD). Application of computational fluid dynamics to derive fractional flow reserve (FFR) eliminates the potential complications associated with hyperaemia and introduction of wires into the coronary arteries. The novel modality has shown consistent accuracy in lesion selection for percutaneous coronary intervention (PCI) and has potential to increase adoption of coronary physiological assessment in Malaysia. Objective To assess the 30-month clinical outcomes of PCI deferral, guided by an angiography based fractional flow reserve (CAFFR) system and the agreement of this application with quantitative flow ratio (QFR) and wired based FFR. The primary end point was a composite of death from any cause, myocardial infarction (MI) or target vessel revascularization (TVR). Methods A prospective, single centre study was conducted from December 2019 to June 2020 involving 69 patients (93 vessels) with angiographic stenosis of 30%-90%. PCI deferral was elected for 29 patients with CAFFR of more than 0.80. Wired FFR was done for comparison at the operator’s discretion. QFR analysis was carried out offline on patients with 2 angiographic views 25 degree apart to compare respective values. Results Amongst the patients who had PCI deferral, 83% were male. The mean age was 59.9 ± 12.6 years old. 12 (41%) patients were diabetic, 18 (62.1%) were hypertensive, 17 (60%) had dyslipidemia and 18 (62%) had a smoking history. The mean LVEF was 53+/-11.4%. 22 (76%) of the patients had a recent acute coronary syndrome. LAD artery was assessed in 16 (52%) vessels. The mean CAFFR, FFR and QFR was 0.80 ± 0.05, 0.89 ± 0.05 and 0.83 ± 0.05 respectively. There were no significant discrepancies between the values with narrow limits of agreement in Bland-Altman plots comparing each modality. There was no statistically significant proportional bias for the Bland Altman plots of CaFFR vs FFR, QFR vs FFR, however there was a significant proportional bias for the Bland-Altman plot for QFR vs CaFFR (linear regression t test: t=2.249, p = 0.031). In general, all three modalities showed good correspondence in significant (<0.80) and non-significant values (>0.80). There were zero procedural complications from CAFFR measurement and similarly for QFR measurements which were conducted offline. At 30 months, all 29 patients were alive. 2 patient (6.8%) met the primary end point (TVR for angina). 89.6% (26) patients remained in CCS class 1 on follow up. Conclusion The 30-month outcome data illustrates the efficacy of PCI deferral utilizing non-wired based techniques that is comparable to the gold standard wired FFR. Future research with a larger sample size and longer follow-up is desired. Elsevier 2023-04-02 Article PeerReviewed text en http://ir.unimas.my/id/eprint/43922/4/chow.pdf Chow, Han Bing and Chandan, Bhavnani and Ho, Kian Hui and Ting, Tan Chen and Francis, Shu and Koh, Keng Tat and Oon, Yen Yee and Asri, Said and Alan, Fong and Ong, Tiong Kiam (2023) Agreement of Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience. Journal of the American College of Cardiology, 81 (16Supp). ISSN 1558-3597 https://www.jacc.org/doi/full/10.1016/j.jacc.2023.03.090
institution Universiti Malaysia Sarawak
building Centre for Academic Information Services (CAIS)
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaysia Sarawak
content_source UNIMAS Institutional Repository
url_provider http://ir.unimas.my/
language English
topic RC Internal medicine
spellingShingle RC Internal medicine
Chow, Han Bing
Chandan, Bhavnani
Ho, Kian Hui
Ting, Tan Chen
Francis, Shu
Koh, Keng Tat
Oon, Yen Yee
Asri, Said
Alan, Fong
Ong, Tiong Kiam
Agreement of Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience
description Background Coronary physiological is recommended in contemporary guidelines to measure non flow limiting stenosis in patients with stable coronary artery disease (CAD). Application of computational fluid dynamics to derive fractional flow reserve (FFR) eliminates the potential complications associated with hyperaemia and introduction of wires into the coronary arteries. The novel modality has shown consistent accuracy in lesion selection for percutaneous coronary intervention (PCI) and has potential to increase adoption of coronary physiological assessment in Malaysia. Objective To assess the 30-month clinical outcomes of PCI deferral, guided by an angiography based fractional flow reserve (CAFFR) system and the agreement of this application with quantitative flow ratio (QFR) and wired based FFR. The primary end point was a composite of death from any cause, myocardial infarction (MI) or target vessel revascularization (TVR). Methods A prospective, single centre study was conducted from December 2019 to June 2020 involving 69 patients (93 vessels) with angiographic stenosis of 30%-90%. PCI deferral was elected for 29 patients with CAFFR of more than 0.80. Wired FFR was done for comparison at the operator’s discretion. QFR analysis was carried out offline on patients with 2 angiographic views 25 degree apart to compare respective values. Results Amongst the patients who had PCI deferral, 83% were male. The mean age was 59.9 ± 12.6 years old. 12 (41%) patients were diabetic, 18 (62.1%) were hypertensive, 17 (60%) had dyslipidemia and 18 (62%) had a smoking history. The mean LVEF was 53+/-11.4%. 22 (76%) of the patients had a recent acute coronary syndrome. LAD artery was assessed in 16 (52%) vessels. The mean CAFFR, FFR and QFR was 0.80 ± 0.05, 0.89 ± 0.05 and 0.83 ± 0.05 respectively. There were no significant discrepancies between the values with narrow limits of agreement in Bland-Altman plots comparing each modality. There was no statistically significant proportional bias for the Bland Altman plots of CaFFR vs FFR, QFR vs FFR, however there was a significant proportional bias for the Bland-Altman plot for QFR vs CaFFR (linear regression t test: t=2.249, p = 0.031). In general, all three modalities showed good correspondence in significant (<0.80) and non-significant values (>0.80). There were zero procedural complications from CAFFR measurement and similarly for QFR measurements which were conducted offline. At 30 months, all 29 patients were alive. 2 patient (6.8%) met the primary end point (TVR for angina). 89.6% (26) patients remained in CCS class 1 on follow up. Conclusion The 30-month outcome data illustrates the efficacy of PCI deferral utilizing non-wired based techniques that is comparable to the gold standard wired FFR. Future research with a larger sample size and longer follow-up is desired.
format Article
author Chow, Han Bing
Chandan, Bhavnani
Ho, Kian Hui
Ting, Tan Chen
Francis, Shu
Koh, Keng Tat
Oon, Yen Yee
Asri, Said
Alan, Fong
Ong, Tiong Kiam
author_facet Chow, Han Bing
Chandan, Bhavnani
Ho, Kian Hui
Ting, Tan Chen
Francis, Shu
Koh, Keng Tat
Oon, Yen Yee
Asri, Said
Alan, Fong
Ong, Tiong Kiam
author_sort Chow, Han Bing
title Agreement of Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience
title_short Agreement of Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience
title_full Agreement of Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience
title_fullStr Agreement of Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience
title_full_unstemmed Agreement of Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience
title_sort agreement of different angiography-derived modalities with wire-based fractional flow reserve systems and 30 month clinical outcomes in evaluation of non-hemodynamically significant obstructive coronary artery disease, a single centre experience
publisher Elsevier
publishDate 2023
url http://ir.unimas.my/id/eprint/43922/4/chow.pdf
http://ir.unimas.my/id/eprint/43922/
https://www.jacc.org/doi/full/10.1016/j.jacc.2023.03.090
_version_ 1787140554756194304
score 13.211869

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