• Martijn Meuwissen, ChamuleauSteven A JSA, Maria Siebes, Robbert J de Winter, Karel T Koch, Lea M Dijksman, Anja J van den Berg, Jan G P Tijssen, Jos A E Spaan, and Jan J Piek.
• Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. m.meuwissen@amc.uva.nl
• Catheter Cardiovasc Interv. 2008 Feb 15; 71 (3): 291-7.

ObjectivesWe evaluated deferral of PCI of intermediate coronary lesions (IL) using fractional (FFR) and coronary flow reserve (CFR) hyperemic stenosis resistance index (HSR) in patients with a negative or nondiagnostic and noninvasive stress tests.BackgroundOutcome after deferral of PCI of IL with discordant results between FFR and CFR is unknown.MethodsPCI was deferred in 186 IL (mean diameter stenosis: 52%). Patients were divided according to the results of FFR and CFR in group A; FFR >or= 0.75 and CFR >or= 2.0 (n = 129), group B; FFR >or= 0.75 and CFR 2.0 (n = 28), group C; FFR 0.75 and CFR >or= 2.0 (n = 23) and group D; FFR 0.75 and CFR 2.0 (n = 6). Patients were followed for one year to document major adverse cardiac events (MACE).ResultsNineteen MACEs (0 deaths, 4 myocardial infarctions, 1 CABG, and 14 PCIs) occurred during a follow up of 323 +/- 88 days. MACE rate was lowest (4.7%) when FFR, CFR, and HSR were normal. A higher MACE rate was observed when concordant abnormal (group D) or discordant results between FFR and CFR (group B and C) were compared to concordant normal values (group A, 33.3% vs. 19.7% vs. 5.4%, P = 0.008). Multivariate regression analysis showed a higher predictive power for HSR than for FFR and CFR.ConclusionsAbnormal FFR or abnormal CFR was documented in 31% of intermediate coronary lesions. Deferral of PCI in this group was associated with a high MACE rate, which underscores the rationale of combined pressure and flow measurements providing a stenosis resistance index that is better suited for clinical decision making in these lesions.(c) 2008 Wiley-Liss, Inc.

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