Author + information
- Received June 26, 2012
- Revision received July 10, 2012
- Accepted July 19, 2012
- Published online October 1, 2012.
- Seung-Jung Park, MD, PhD⁎,⁎ (, )
- Soo-Jin Kang, MD, PhD⁎,
- Jung-Min Ahn, MD⁎,
- Eun Bo Shim, PhD†,
- Young-Tae Kim, PhD†,
- Sung-Cheol Yun, PhD‡,
- Haegeun Song, MD⁎,
- Jong-Young Lee, MD⁎,
- Won-Jang Kim, MD⁎,
- Duk-Woo Park, MD, PhD⁎,
- Seung-Whan Lee, MD, PhD⁎,
- Young-Hak Kim, MD, PhD⁎,
- Cheol Whan Lee, MD, PhD⁎,
- Gary S. Mintz, MD§ and
- Seong-Wook Park, MD, PhD⁎
- ↵⁎Reprint requests and correspondence:
Prof. Seung-Jung Park, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
Objectives The goal of this study was to identify clinical and lesion-specific local factors affecting visual-functional mismatch.
Background Although lesion severity determined by coronary angiography has not been well correlated with physiological significance, the mechanism of the discordance remains poorly understood.
Methods The authors assessed quantitative coronary angiography, intravascular ultrasound (IVUS), and fractional flow reserve (FFR) in a prospective cohort of 1,000 patients with 1,129 coronary lesions. Three-dimensional computational simulation studies were performed.
Results Lesions with angiographic diameter stenosis (DS) ≥50% and FFR >0.80 (“mismatches”) were seen in 57% of non–left main lesions and in 35% of the left main lesions, respectively (p = 0.032). Conversely, among the lesions with DS <50% and FFR <0.80 (“reverse mismatches”) 16% were found in the non–left main lesions and 40% in the left main lesions (p < 0.001). The independent predictors for mismatch were advanced age, non–left anterior descending artery location, absence of plaque rupture, short lesion length, large minimal lumen area, smaller plaque burden, and greater minimal lumen diameter. Conversely, reverse mismatch was independently associated with younger age, left anterior descending artery location, the presence of plaque rupture, a smaller minimal lumen area, and larger plaque burden. In a computational simulation study, FFR was influenced by DS, lesion length, different lesion shape, plaque eccentricity, surface roughness, and various shapes of plaque rupture.
Conclusions There were high frequencies of visual-functional mismatch between angiography and FFR. The discrepancy was related to the clinical and lesion-specific factors frequently unrecognizable by angiography, thus suggesting that coronary angiography cannot accurately predict FFR.
(Natural History of FFR-Guided Deferred Coronary Lesions [IRIS FFR-DEFER]; NCT01366404)
Funding was provided by the Cardiovascular Research Foundation and St. Jude Medical. Funders did not participate in the selection or management of the patients or in the collection and analysis of the data. The principal investigator had unrestricted access to the data after the database was locked, made the decision to submit the manuscript for publication, prepared all drafts of the manuscript, and vouched for the integrity of the trial as well as the completeness and accuracy of the reported data. No agreements exist regarding confidentiality of the data among the funding company, sponsors, and the investigators. All the authors have received grant support from the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A102065). Dr. Mintz has received grants or consulted for BostonScientific, Volcano, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first two authors contributed equally to this paper.
- Received June 26, 2012.
- Revision received July 10, 2012.
- Accepted July 19, 2012.
- American College of Cardiology Foundation