Anatomical-functional discordance between quantitative coronary angiography and diastolic pressure ratio during wave-free period

Objectives: This study sought to determine the predictors of anatomical-functional discordance between quantitative coronary angiography (QCA) derived diameter stenosis (QCA-DS) and diastolic pressure ratio during wave-free period (dPR_WFP ).

Background: The discrepancy between angiographical stenosis and physiological significance is frequently experienced in clinical practice. Although the anatomical-functional discordance between angiography and fractional flow reserve (FFR) has been intensively investigated, that of resting index including dPR_WFP remains to be elucidated.

Methods: In a total of 647 angiographically intermediate lesions with QCA-DS between 30 and 70% in 502 patients, predictors of having QCA-DS >50% and dPR_WFP > 0.89 (QCA-dPR_WFP mismatch), and those of having QCA-DS ≤50% and dPR_WFP ≤ 0.89 (QCA-dPR_WFP reverse mismatch) were determined. FFR ≤0.80 was defined as positive FFR and the predictors of QCA-FFR discordance were determined as well.

Results: QCA-dPR_WFP mismatch and reverse mismatch were observed in 27.5 and 17.6% of cases, respectively. The predictors of mismatch were non-left anterior descending artery (LAD) lesion, large minimal lumen diameter, low baseline heart rate, and high coronary flow reserve (CFR), while those of reverse mismatch were LAD lesion, non-culprit lesion of acute coronary syndrome, long lesion length, low left ventricular ejection fraction, and low CFR and index of microcirculatory resistance. Age, sex, and the culprit vessel of prior myocardial infarction were not significant determinants of QCA-dPR_WFP discordance unlike QCA-FFR discordance derived from the same cohort.

Conclusions: Anatomical-functional discordance between angiography and dPR_WFP was not uncommon. Predictors differed between QCA-dPR_WFP discordance and QCA-FFR discordance.