Author + information
- Ron Waksman1,
- Jacek Legutko2,
- Jasvindar Singh3,
- Quentin Orlando4,
- Steven Marso5,
- Timothy Schloss6,
- James DeVries7,
- Nicholas Palmer8,
- Michael Haude9,
- Stacy Swymelar1 and
- Rebecca Torguson1
Assessment of intermediate coronary lesions is still challenging. Fractional flow reserve (FFR) measurements of 0.8 or lower are considered clinically significant for physiological ischemia. Intravascular Ultrasound minimal lumen area (IVUS MLA) was suggested to correlate with FFR for the determination of significant Stenosis. This study aimed to examine gender differences for the IVUS MLA cutoff.
The FIRST trial is a multi-center, prospective, international registry of patients with intermediate coronary lesions defined as a stenosis of 40-80% by angiography. A total of 350 patients, 367 lesions were enrolled into the study at 10 sites in the United States and Europe. Patients were followed up to hospital discharge. The primary end point was a correlation between MLA and FFR and to identity a cut-off value for MLA corresponding to FFR of 0.8. This sub-analysis examines the differences and correlations between males and females, where there were 260 males and 90 females in the study population.
A receiver operating characteristic curve (ROC) identified MLA <3.1 mm2 (sensitivity 64.1%, specificity 64.9%) as the best threshold value for FFR <0.8. The same analysis between men and women showed, the minimum lumen area (MLA) cut-off for males was 3.19 mm2 (sensitivity 63.8%, specificity 64.7%, r=0.315), and 2.57 mm2 (sensitivity 65.0%, specificity 72.2%, r=0.294) for females.
Anatomic measurements of intermediate coronary lesions obtained by IVUS show a moderate correlation to FFR values. The MLA cutoff for female is smaller when compared to Male. These findings are correlated to smaller vessel size in female and should be taken into account when IVUS MLA is used for assessment of severity of intermediate lesions.
|Overall (n=344)||Male (n=242)||Female (n=92)||P Value|
|LAD||190 (56.9%)||133 (55.0%)||57 (62.0%)||0.249|
|LCX||60 (18.0%)||44 (18.2%)||16 (17.4%)||0.866|
|RCA||80 (24.0%)||62 (25.6%)||18 (19.6%)||0.247|
|Proximal||110 (32.9%)||86 (35.5%)||24 (26.1%)||0.101|
|Mid||198 (59.3%)||141 (58.3%)||57 (62.0%)||0.540|
|Distal||19 (5.7%)||12 (5.0%)||7 (7.6%)||0.350|
|Pre RVD||2.97 ± 0.58||3.01 ± 0.59||2.87 ± 0.54||0.063|
- 2013 American College of Cardiology Foundation