Angiography-Derived FFR: Complicated Software or Imminent Reality?

Angiography-derived fractional flow reserve (FFR) demonstrated substantial usefulness, especially in patients with three-vessel lesions. The functional SYNTAX score derived from angiography has the potential to redefine prognosis and treatment strategies compared with the classic anatomical SYNTAX score.

This study sought to investigate the applicability of this method in patients with multivessel lesions included in the SYNTAX II trial and to prove the usefulness of the functional score (as opposed to the anatomical score featured in the first SYNTAX trial).

All lesions assessed with instantaneous wave-free ratio (iFR) and/or FFR in the SYNTAX II trial were retrospectively analyzed to determine the feasibility of angiography-derived functional assessment.

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Patients analyzed with angiography-derived FFR were stratified according to its result, assessing their 2-year clinical prognosis.

The software was able to analyze 71% of the lesions, and its diagnostic performance to predict binary ischemia was substantial compared with FFR or iFR (area under the curve: 0.81; accuracy: 73.8%) with a positive predictive value of 85.9%.

The factors that interfered with its precision were lesions in side branches, bifurcation lesions, or small vessels.

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According to the 2-year combined endpoint, the angiography-derived functional assessment reclassified 26.1% of the patients in high/intermediate risk group into low risk group appropriately.

The area under the curve for the angiography-derived functional assessment predicting 2-year events was higher than that of the classic anatomical SYNTAX score (0.68 vs. 0.56; p = 0.002).

Original title: Angiography-Derived Fractional Flow Reserve in the SYNTAX II Trial. Feasibility, Diagnostic Performance of Quantitative Flow Ratio, and Clinical Prognostic Value of Functional SYNTAX Score Derived from Quantitative Flow Ratio in Patients with 3-Vessel Disease.

Reference: Taku Asano et al. Am Coll Cardiol Intv 2019;12:259–70.

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