Affiliation:
1. From the Cardiovascular Center Aalst, Belgium (J.A., P.X., A.F., M.P., G.C., V.F., E.B., B.D.B.); and Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (E.B.).
Abstract
Background—
The correlation between angiographic assessment of coronary stenoses and fractional flow reserve (FFR) is weak. Whether and how risk factors impact the diagnostic accuracy of angiography is unknown. We sought to evaluate the diagnostic accuracy of angiography by visual estimate and by quantitative coronary angiography when compared with FFR and evaluate the influence of risk factors (RF) on this accuracy.
Methods and Results—
In 1382 coronary stenoses (1104 patients), percent diameter stenosis by visual estimation (DS
VE
) and by quantitative coronary angiography (DS
QCA
) was compared with FFR. Patients were divided into 4 subgroups, according to the presence of RFs, and the relationship between DS
VE
, DS
QCA
, and FFR was analyzed. Overall, DS
VE
was significantly higher than DS
QCA
(
P
<0.0001); nonetheless, when examined by strata of DS, DS
VE
was significantly smaller than DS
QCA
in mild stenoses, although the reverse held true for severe stenoses. Compared with FFR, a large scatter was observed for both DS
VE
and DS
QCA
. When using a dichotomous FFR value of 0.80, C statistic was significantly higher for DS
VE
than for DS
QCA
(0.712 versus 0.640, respectively;
P
<0.001). C statistics for DS
VE
decreased progressively as RFs accumulated (0.776 for ≤1 RF, 0.750 for 2 RFs, 0.713 for 3 RFs and 0.627 for ≥4 RFs;
P
=0.0053). In addition, in diabetics, the relationship between FFR and angiographic indices was particularly weak (C statistics: 0.524 for DS
VE
and 0.511 for DS
QCA
).
Conclusions—
Overall, DS
VE
has a better diagnostic accuracy than DS
QCA
to predict the functional significance of coronary stenosis. The predictive accuracy of angiography is moderate in patients with ≤1 RFs, but weakens as RFs accumulate, especially in diabetics.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging
Cited by
41 articles.
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