The regional difference in severe coronary artery disease between fractional flow reserve and intravascular ultrasound

Background: Both fractional flow reserve (FFR)-guided and intravascular ultrasound (IVUS)-guided strategies have been reported to safe and effective in coronary lesions. However, we are clinically in a dilemma between IVUS-minimum lumen area (MLA)≤4.0mm2 and FFR>0.80 (defined as "Mismatch diseases") in severe coronary artery stenosis (defined as 75% to 90% diameter stenosis by visual assessment), especially in non-LAD lesions. Method: FFR and IVUS measurements were performed in 122 lesions (LAD: 66 lesions and non-LAD: 56 lesions) of severe coronary stenosis (95 stable patients) that located at the proximal or mid part of major coronary artery. Acute coronary syndrome, LMT lesions, tandem lesions, and CABG cases were excluded. The FFR value was checked after intracoronary administration of papaverin to induce maximal hyperemia. We divided into LAD and non-LAD lesions and compared a prevalence of mismatch diseases in LAD lesions and that in non-LAD lesions. The ROC analysis was performed to evaluate IVUS-MLA for estimating FFR≤0.80 in each lesions. Result: A prevalence of mismatch diseases in non-LAD lesions was significantly higher than that in LAD lesions (LAD vs. non-LAD; 21.2% vs. 67.8%, p<0.05). The best cutoff value of IVUS-MLA in FFR≤0.80 were also significantly different between LAD and non-LAD lesions (LAD vs. non-LAD; 3.20mm2 vs. 2.07mm2, p<0.05). ![Figure][1] FFR vs. IVUS-MLA Conclusion: There were many mismatch diseases in severe coronary artery stenosis of non-LAD lesions. IVUS-MLA cannot accurately predict FFR. FFR measurement can prevent unnecessary PCI, especially in non-LAD lesions. [1]: pending:yes