Long Term Outcomes of Hyperemic Stenosis Resistance Index (HSR) in Patients with Stable Chronic Angina

The hyperemic stenosis resistance index (HSR) was introduced as a more complete hemodynamic severity indicator of a coronary lesion. HSR combines both pressure drop across a lesion and the flow through it, therefore overcoming the limitations of traditional indices such as fractional flow reserve (FFR) and coronary flow reserve (CFR).

Pronóstico al año en lesiones ateroscleróticas vs las no ateroscleróticas en pacientes con MINOCA

The aim of this multicenter study was to assess the diagnostic and prognostic value of HSR, as well as clinical outcomes.  Primary end point was target vessel failure (TVF), defined as combination of cardiac death, myocardial infarction (AMI) and clinically driven target vessel revascularization.

It included a total 853 patients with 1,107 vessels. Patient mean age was 63 and they were mostly men. The most assessed vessel was the anterior descending artery (57%), followed by the circumflex (24%) and the right coronary (19%). HSR identified more accurately the presence of inducible ischemia vs. FFR and CFR (area under the curve 0,71 vs 0,66 and 0,62, respectively; p<0,005 for both).

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An abnormal HSR measurement was an independent and important predictor of target vessel failure at 5 year followup (HR 3,80, CI 95%: 2,12-6,73; p<0,005). On deferred vessels, HSR seems to identify more accurately those that could benefit from revascularization, vs FFR and / or CFR. 


The present study confirms the diagnostic value of HSR for to detect ischemia in coronary lesions. This registry is the first to show the prognostic importance of HSR based on long term risk of TVF. We need more prospective studies to confirm these findings.

Dr. Andrés Rodríguez

Dr. Andrés Rodríguez.
Membro do Conselho Editorial da SOLACI.org.

Título Original: Impact of hyperaemic stenosis resistance on long-term outcomes of stable angina in the ILIAS Registry.

Referência: Coen K.M. Boerhout , MD et al EuroIntervention 2024;20:e699-e706.

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