Coronary disease & ACSCohort study
Prevalence and Clinical Outcomes of Discordant Lesions Between Fractional Flow Reserve and Nonhyperemic Pressure Ratios in Clinical Practice: The J-PRIDE Registry
- Prospective multicentre registry study
- 20 Japanese centres
- lesion-level analysis
Authors' conclusion
Discordance between FFR and NHPRs was noted in 20% of lesions, and discordant deferred lesions resulted in worse outcomes than concordant negative lesions. Although the outcomes after deferring revascularization were comparable between the FFR+/NHPR- and FFR-/NHPR+ lesions, only FFR+/NHPR- lesions showed a benefit from revascularization compared with medical treatment
Study context
- Population
- Patients with CAD assessed by fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs), 20 Japanese centres
- Participants
- 3,200 patients · 4,304 lesions
- Exposure
- Discordant vs concordant FFR and NHPR lesions
- Outcome
- Target vessel failure (cardiac death, target vessel-related MI, clinically driven target vessel revascularization), lesion basis
- Follow-up
- 1 year
Main finding
As reported in the abstract
Target vessel failure in deferred vessels
Each group vs FFR-/NHPR-Adjusted hazard ratio (95% CI)P value
FFR+/NHPR-
4.89(2.68–8.91)
P < 0.001FFR-/NHPR+
2.64(1.49–4.69)
P < 0.001Observational data: associations, not effects.
Further findings
| Outcome | Values | aHR (95% CI) | P value | |
|---|---|---|---|---|
| Target vessel failure in revascularized vessels · 1 year — FFR-/NHPR+ vs FFR+/NHPR+ | FFR-/NHPR+ 9.6% · FFR+/NHPR- 2.3% · FFR+/NHPR+ 3.4% | 2.27 (0.70–7.34) | P = 0.17 | |
| Target vessel failure in revascularized vessels · 1 year — FFR+/NHPR- vs FFR+/NHPR+ | 0.96 (0.37–2.38) | P = 0.93 | ||
| Revascularization vs medical treatment, by discordance type — Revascularization vs Medical treatment · FFR+/NHPR- | 0.26 (0.08–0.86) | P = 0.027 | ||
| Revascularization vs medical treatment, by discordance type — Revascularization vs Medical treatment · FFR-/NHPR+ | 2.39 (0.62–9.21) | P = 0.20 | ||
| 0.050.21520Adjusted hazard ratio (log scale) |
| Outcome | Values | Estimate | P value |
|---|---|---|---|
| Prevalence of FFR–NHPR discordance | FFR+/NHPR- 11.2% · FFR-/NHPR+ 8.8% | ||
| Revascularization deferred | FFR+/NHPR- 42.9% · FFR-/NHPR+ 88.4% |
- Prevalence of FFR–NHPR discordance — Discordance overall (% of lesions)
- 20%
Original publication
Prevalence and Clinical Outcomes of Discordant Lesions Between Fractional Flow Reserve and Nonhyperemic Pressure Ratios in Clinical Practice: The J-PRIDE Registry. Circulation. Published 9 January 2025. doi:10.1161/circulationaha.124.071139
Summarised from the published abstract; every number is checked against it