Diagnostic Value of Relative Flow Reserve in Patients With Prior Coronary Artery Disease: A Post Hoc Analysis of the PACIFIC-2 Trial
Authors' conclusion
However, RFR does not outperform absolute hyperemic myocardial perfusion for detecting FFR-defined significant CAD in patients with prior CAD and recurrence of symptoms.
Study context
- Population
- Symptomatic patients with prior MI and/or PCI undergoing [15O]H2O PET perfusion imaging and invasive coronary angiography with 3-vessel fractional flow reserve (FFR)optimal cohort n = 80
- Participants
- 187 patients
- Comparison
- Relative flow reserve (RFR) vs hyperemic myocardial blood flow (hMBF) by [15O]H2O PET for detecting FFR-defined significant coronary artery disease (CAD)
- Primary endpoint
- Diagnostic performance (C statistic) for hemodynamically significant CAD (FFR ≤0.80)
Methodological detailspost hoc analysis
- Post hoc analysis
Primary result
As reported in the abstract
C statistic for FFR-defined significant CAD
| Group | C statistic, overall cohort | C statistic, optimal cohort |
|---|---|---|
| hMBF | 0.81 | 0.79 |
| RFR | 0.78 | 0.82 |
C statistic, overall cohort
hMBF0.81
RFR0.78
C statistic, optimal cohort
hMBF0.79
RFR0.82
- hMBF vs RFR: P = 0.288 — overall cohort
- hMBF vs RFR: P = 0.512 — optimal cohort
Further findings
Correlation between RFR and FFR
- Overall cohort
- 0.42
- Optimal cohort
- 0.52
- P<0.001 for both
Prevalence of significant CAD
- Overall cohort
- 87 (47%)
- Optimal cohort
- 43 (54%)
Original publication
Diagnostic Value of Relative Flow Reserve in Patients With Prior Coronary Artery Disease: A Post Hoc Analysis of the PACIFIC-2 Trial. Circ Cardiovasc Imaging. Published 30 August 2025. doi:10.
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