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Multicenter Study
. 2024 Jul;113(7):1081-1091.
doi: 10.1007/s00392-024-02463-w. Epub 2024 Jun 4.

Use of coronary physiology to guide revascularization in clinical practice: results of the F(FR)2 registry

J Michael Altstidl  1 , Stephan Achenbach  1 , Johannes Feyrer  1 , J Benedikt Nazli  1 , Mohamed Marwan  1 , Luise Gaede  1 , Helge Möllmann  2 , Tom Giesler  3 , Harald Rittger  4 , Matthias Pauschinger  5 , Tanja K Rudolph  6 , Werner Moshage  7 , Martin Brück  8 , Monique Tröbs  9
Affiliations
Multicenter Study

Use of coronary physiology to guide revascularization in clinical practice: results of the F(FR)2 registry

J Michael Altstidl et al. Clin Res Cardiol. 2024 Jul.

Abstract

Background: Despite the recommendation of coronary physiology to guide revascularization in angiographically intermediate stenoses without established correlation to ischemia, its uptake in clinical practice is slow.

Aims: This study aimed to analyze the use of coronary physiology in clinical practice.

Methods: Based on a multicenter registry (Fractional Flow Reserve Fax Registry, F(FR)2, ClinicalTrials.gov identifier NCT03055910), clinical use, consequences, and complications of coronary physiology were systematically analyzed.

Results: F(FR)2 enrolled 2,000 patients with 3,378 intracoronary pressure measurements. Most measurements (96.8%) were performed in angiographically intermediate stenoses. Out of 3,238 lesions in which coronary physiology was used to guide revascularization, revascularization was deferred in 2,643 (78.2%) cases. Fractional flow reserve (FFR) was the most common pressure index used (87.6%), with hyperemia induced by an intracoronary bolus of adenosine in 2,556 lesions (86.4%) and intravenous adenosine used for 384 measurements (13.0%). The route of adenosine administration did not influence FFR results (change-in-estimate -3.1% for regression model predicting FFR from diameter stenosis). Agreement with the subsequent revascularization decision was 93.4% for intravenous and 95.0% for intracoronary adenosine (p = 0.261). Coronary artery occlusion caused by the pressure wire was reported in two cases (0.1%) and dissection in three cases (0.2%), which was fatal once (0.1%).

Conclusions: In clinical practice, intracoronary pressure measurements are mostly used to guide revascularization decisions in angiographically intermediate stenoses. Intracoronary and intravenous administration of adenosine seem equally suited. While the rate of serious complications of wire-based intracoronary pressure measurements in clinical practice seems to be low, it is not negligible.

Keywords: Complications; Coronary artery disease; Coronary physiology; Fractional flow reserve (FFR); Registry.

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Conflict of interest statement

Luise Gaede received speaker honorarium from SMT, Boston Scientific, Edwards Lifesciences, Abbott Laboratories, Abiomed, AstraZeneca, and Shockwave Medical. Mohamed Marwan received speaker honorarium from Edwards Lifesciences and Siemens Healthineers. Helge Möllmann received consulting fees from Boston Scientific, speaker honorarium from Boston Scientific, Abbott Laboratories, Medtronic, and SMT, and travel funding from Boston Scientific and Abbott Vascular. Tanja K. Rudolph received consulting fees from Medtronic and JenaValve and speaker honorarium from Abbott Laboratories, Medtronic, Amgen, Boston Scientific, Edwards Lifesciences, and JenaValve. Monique Tröbs received speaker honorarium from Abbott Laboratories, Pfizer, and Bristol Myers Squibb and travel funding from Abbott Laboratories and participates in the Pfizer Advisory Board. All other authors have no conflicts of interest to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Distribution of pressure measurements and diameter stenosis. a Distribution of FFR measurement results. b Distribution of iFR measurement results. c Distribution of Pd/Pa measurement results. d Distribution of diameter stenosis
Fig. 2
Fig. 2
Use of coronary physiology in clinical practice. a Choice of intracoronary pressure index in clinical practice. b Revascularization decision after intracoronary pressure measurement for guidance of revascularization in clinical practice
Fig. 3
Fig. 3
Intravenous versus intracoronary adenosine. a Relative distribution of FFR measurement results for intravenous and intracoronary administration of adenosine. b Relative distribution of visually estimated diameter stenosis for intravenous and intracoronary administration of adenosine. c Correlation of diameter stenosis with FFR for intravenously administered adenosine. d Correlation of diameter stenosis with FFR for intracoronary administered adenosine (iv = intravenous, ic = intracoronary)
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