Predicting the Physiological Effect of Revascularization in Serially Diseased Coronary Arteries

Fractional flow reserve (FFR) is commonly used to assess the functional significance of coronary artery disease but is theoretically limited in evaluating individual stenoses in serially diseased vessels. We sought to characterize the accuracy of assessing individual stenoses in serial disease using invasive FFR pullback and the noninvasive equivalent, fractional flow reserve by computed tomography (FFR ). We subsequently describe and test the accuracy of a novel noninvasive FFR -derived percutaneous coronary intervention (PCI) planning tool (FFR ) in predicting the true significance of individual stenoses. Patients with angiographic serial coronary artery disease scheduled for PCI were enrolled and underwent prospective coronary CT angiography with conventional FFR -derived post hoc for each vessel and stenosis (FFR ). Before PCI, the invasive hyperemic pressure-wire pullback was performed to derive the apparent FFR contribution of each stenosis (FFR ). The true FFR attributable to individual lesions (FFR ) was then measured following PCI of one of the lesions. The predictive accuracy of FFR , FFR , and the novel technique (FFR ) was then assessed against FFR . From the 24 patients undergoing the protocol, 19 vessels had post hoc FFR and FFR calculation. When assessing the distal effect of all lesions, FFR correlated moderately well with invasive FFR ( R=0.71; P