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Evaluation of functional significance of stenotic lesions in small coronary artery according to the territory of blood supply by comparing with FFR

Tahk, Seung-Jea; Yoon, Myeong-Ho; Yang, Hyoung Mo; Koo, Bon Kwon; Nam, Chang Wook; Do, Joon Hyung; Lim, Hong-Seok; Choi, Byoung-Joo; Choi, So-Yeon; Hwang, Gyo-Seung; Shin, Joon-Han; Cho, Dae-Yeol; Seo, Kyung-Woo; Kim, Jin-Woo
Department of Cardiology
Background and Purpose:Fractional flow reserve (FFR) is a physiologic parameter for specific epicardial coronary stenotic severity and it is affected by the amount of myocardium which the target lesion supplies. The purpose of this study was to evaluate the usefulness of FFR to determine PCI in small vessel (vessel diameter 30% diameter stenosis (DS) by angiography in small coronary vessels without myocardial infarction. The lesions were divided into two groups. Group(A): the lesion located at the proximal to mid segments of left coronary artery or segments proximal to crux of right coronary artery (RCA) (n=387). Group (B): the lesion located at distal segments or branches of left coronary artery or segments distal to crux of RCA(n=157). DS and minimal lumen diameter (MLD) had weak correlation with FFR (r=-0.378, p<0.001; r=0.373, p<0.001), respectively. FFR was higher in group B (0.79 ±0.12 vs. 0.83 ± 0.10 p<0.001), however, DS was more severe compared to group A (60.9 ± 13.9% vs. 55.9 ± 3.7%) The best cutoff value of DS for prediction FFR<0.8 was 59.56% (AUC:0.691, 95% CI:0.650-0.729) in total lesions; 53.11% (AUC : 0.720, 95% CI: 0.672-0.764) in group A and 60.00% (AUC: 0.669, 95% CI:0. 590-0.742) in group B. Conclusions: Functional significance of stenotic lesion of small coronary vessels depends on both of the severity of stenosis and the location of lesion. Coronary angiography overestimates the significance of stenosis, especially when the lesion located at distal segments or branches.
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