Operator decision-making in angiography-only guided revascularization for lesions not indicated for FFR: a QFR-based functional assessment in chronic coronary syndrome
BackgroundDiscordance between coronary angiographic findings and invasive functional significance is well-established. Yet, the prevalence of this mismatch in an era increasingly utilizing invasive functional assessments, such as fractional flow reserve (FFR), remains unclear. This study examines th...
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| Format: | Article |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1336341/full |
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| author | Sadeek S. Kanoun Schnur Sadeek S. Kanoun Schnur Sadeek S. Kanoun Schnur Robertas Pranevičius Robertas Pranevičius Cosima Stark Dan Prunea Dan Prunea Judit Andreka Judit Andreka Albrecht Schmidt Stefan Harb Zoltan Ruzsa Robert Zweiker Jesse Kane Gabor G. Toth |
| author_facet | Sadeek S. Kanoun Schnur Sadeek S. Kanoun Schnur Sadeek S. Kanoun Schnur Robertas Pranevičius Robertas Pranevičius Cosima Stark Dan Prunea Dan Prunea Judit Andreka Judit Andreka Albrecht Schmidt Stefan Harb Zoltan Ruzsa Robert Zweiker Jesse Kane Gabor G. Toth |
| author_sort | Sadeek S. Kanoun Schnur |
| collection | DOAJ |
| description | BackgroundDiscordance between coronary angiographic findings and invasive functional significance is well-established. Yet, the prevalence of this mismatch in an era increasingly utilizing invasive functional assessments, such as fractional flow reserve (FFR), remains unclear. This study examines the extent of such discrepancies in current clinical practice.MethodsThis single-center prospective registry included consecutive patients with chronic coronary syndrome (CCS) who underwent elective coronary angiography, with or without revascularization. Coronary angiograms deemed not requiring FFR due to clear anatomical distinctions, either anatomically severe indicating a need for revascularization or mild suggesting no need for intervention, were selected for evaluation. These were then subjected to post-hoc analysis by three independent operators who were blinded to the definitive treatment strategies. Importantly, the post-hoc analysis was conducted in two distinct phases: firstly, a re-evaluation of coronary stenosis, and secondly, a separate functional assessment, each carried out independently. Coronary stenosis severity was assessed visually, while functional relevance was determined by quantitative flow ratio (QFR), calculated using a computational fluid dynamics algorithm applied to angiographic images. Analysis focused on discrepancies between QFR-based functional indications and revascularization strategies actually performed.ResultsIn 191 patients, 488 vessels were analyzed. Average diameter stenosis (DS) was 37 ± 34%, and QFR was 0.87 ± 0.15, demonstrating a moderate correlation (r = −0.84; 95% CI: −0.86 to −0.81, p < 0.01). Agreement with QFR at conventional anatomical cutoffs was 88% for 50% DS and 91% for 70% DS. Mismatches between revascularization decisions and QFR indications occurred in 10% of cases. Discrepancies were more frequent in the left anterior descending artery (14%) compared to the left circumflex (6%) and the right coronary artery (9%; p = 0.07).ConclusionIn a cardiac-center where FFR utilization is high, discordance between coronary angiography and functional significance persists, even when operators are confident in their decisions not to use functional interrogation. This gap, most evident in the left anterior descending artery, highlights the potential need for integrated angiography-based functional assessments to refine revascularization decisions in CCS. |
| first_indexed | 2024-03-07T21:41:20Z |
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| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-07T21:41:20Z |
| publishDate | 2024-02-01 |
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| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-30e1fd9728f942039c4f62dd8d61e4bc2024-02-26T07:43:30ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-02-011110.3389/fcvm.2024.13363411336341Operator decision-making in angiography-only guided revascularization for lesions not indicated for FFR: a QFR-based functional assessment in chronic coronary syndromeSadeek S. Kanoun Schnur0Sadeek S. Kanoun Schnur1Sadeek S. Kanoun Schnur2Robertas Pranevičius3Robertas Pranevičius4Cosima Stark5Dan Prunea6Dan Prunea7Judit Andreka8Judit Andreka9Albrecht Schmidt10Stefan Harb11Zoltan Ruzsa12Robert Zweiker13Jesse Kane14Gabor G. Toth15Department of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, AustriaPeninsula Deanery, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United KingdomDoctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, HungaryDepartment of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, AustriaDepartment of Cardiology, Heart and Vascular Center, Republican Siauliai Hospital, Siauliai, LithuaniaDepartment of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, AustriaDepartment of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, Austria“Niculae Stancioiu” Heart Institute, University of Medicine “Iuliu Hatieganu”, Cluj-Napoca, RomaniaDepartment of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, AustriaDoctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, HungaryDepartment of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, AustriaDepartment of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, AustriaDoctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, HungaryDepartment of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, AustriaDepartment of Cardiology, University of Vermont Larner College of Medicine, Burlington, VT, United StatesDepartment of Cardiology, UniversityHeart Center Graz, Medical University Graz, Graz, AustriaBackgroundDiscordance between coronary angiographic findings and invasive functional significance is well-established. Yet, the prevalence of this mismatch in an era increasingly utilizing invasive functional assessments, such as fractional flow reserve (FFR), remains unclear. This study examines the extent of such discrepancies in current clinical practice.MethodsThis single-center prospective registry included consecutive patients with chronic coronary syndrome (CCS) who underwent elective coronary angiography, with or without revascularization. Coronary angiograms deemed not requiring FFR due to clear anatomical distinctions, either anatomically severe indicating a need for revascularization or mild suggesting no need for intervention, were selected for evaluation. These were then subjected to post-hoc analysis by three independent operators who were blinded to the definitive treatment strategies. Importantly, the post-hoc analysis was conducted in two distinct phases: firstly, a re-evaluation of coronary stenosis, and secondly, a separate functional assessment, each carried out independently. Coronary stenosis severity was assessed visually, while functional relevance was determined by quantitative flow ratio (QFR), calculated using a computational fluid dynamics algorithm applied to angiographic images. Analysis focused on discrepancies between QFR-based functional indications and revascularization strategies actually performed.ResultsIn 191 patients, 488 vessels were analyzed. Average diameter stenosis (DS) was 37 ± 34%, and QFR was 0.87 ± 0.15, demonstrating a moderate correlation (r = −0.84; 95% CI: −0.86 to −0.81, p < 0.01). Agreement with QFR at conventional anatomical cutoffs was 88% for 50% DS and 91% for 70% DS. Mismatches between revascularization decisions and QFR indications occurred in 10% of cases. Discrepancies were more frequent in the left anterior descending artery (14%) compared to the left circumflex (6%) and the right coronary artery (9%; p = 0.07).ConclusionIn a cardiac-center where FFR utilization is high, discordance between coronary angiography and functional significance persists, even when operators are confident in their decisions not to use functional interrogation. This gap, most evident in the left anterior descending artery, highlights the potential need for integrated angiography-based functional assessments to refine revascularization decisions in CCS.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1336341/fullchronic coronary syndromefunctional misclassificationfractional flow reservequantitative flow ratioangiography guided PCIQFR |
| spellingShingle | Sadeek S. Kanoun Schnur Sadeek S. Kanoun Schnur Sadeek S. Kanoun Schnur Robertas Pranevičius Robertas Pranevičius Cosima Stark Dan Prunea Dan Prunea Judit Andreka Judit Andreka Albrecht Schmidt Stefan Harb Zoltan Ruzsa Robert Zweiker Jesse Kane Gabor G. Toth Operator decision-making in angiography-only guided revascularization for lesions not indicated for FFR: a QFR-based functional assessment in chronic coronary syndrome Frontiers in Cardiovascular Medicine chronic coronary syndrome functional misclassification fractional flow reserve quantitative flow ratio angiography guided PCI QFR |
| title | Operator decision-making in angiography-only guided revascularization for lesions not indicated for FFR: a QFR-based functional assessment in chronic coronary syndrome |
| title_full | Operator decision-making in angiography-only guided revascularization for lesions not indicated for FFR: a QFR-based functional assessment in chronic coronary syndrome |
| title_fullStr | Operator decision-making in angiography-only guided revascularization for lesions not indicated for FFR: a QFR-based functional assessment in chronic coronary syndrome |
| title_full_unstemmed | Operator decision-making in angiography-only guided revascularization for lesions not indicated for FFR: a QFR-based functional assessment in chronic coronary syndrome |
| title_short | Operator decision-making in angiography-only guided revascularization for lesions not indicated for FFR: a QFR-based functional assessment in chronic coronary syndrome |
| title_sort | operator decision making in angiography only guided revascularization for lesions not indicated for ffr a qfr based functional assessment in chronic coronary syndrome |
| topic | chronic coronary syndrome functional misclassification fractional flow reserve quantitative flow ratio angiography guided PCI QFR |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1336341/full |
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