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

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...

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Published in:	Clinical research in cardiology Vol. 113; no. 7; pp. 1081 - 1091
Main Authors:	Altstidl, J. Michael, Achenbach, Stephan, Feyrer, Johannes, Nazli, J. Benedikt, Marwan, Mohamed, Gaede, Luise, Möllmann, Helge, Giesler, Tom, Rittger, Harald, Pauschinger, Matthias, Rudolph, Tanja K., Moshage, Werner, Brück, Martin, Tröbs, Monique
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2024 Springer Nature B.V
Subjects:	Adenosine Adenosine - administration & dosage Aged Cardiac Catheterization - methods Cardiology Clinical medicine Coronary Angiography Coronary artery Coronary Stenosis - diagnosis Coronary Stenosis - physiopathology Coronary Vessels - diagnostic imaging Coronary Vessels - physiopathology Facsimile communication Female Fractional Flow Reserve, Myocardial - physiology Humans Hyperemia Intravenous administration Ischemia Lesions Male Medicine Medicine & Public Health Middle Aged Myocardial Revascularization - methods Occlusion Original Paper Physiology Pressure Registries Regression models Stenosis Vasodilator Agents - administration & dosage Wire Fractional flow reserve (FFR) Coronary physiology Registry Complications Coronary artery disease
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Summary:	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. Graphical abstract
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1861-0684 1861-0692 1861-0692
DOI:	10.1007/s00392-024-02463-w