Impact of Pressure Signal Drift on Fractional Flow Reserve-Based Decision-Making for Patients With Intermediate Coronary Artery Stenosis

Abstract

Background:Fractional flow reserve (FFR) is an important physiological measure of intermediate coronary artery stenosis. Pressure signal drift (PD) is widely recognized but has largely been ignored in FFR measurements. We sought to determine the effect of PD on FFR-derived decision-making.Methods and Results:We analyzed 1,218 FFR measurements for intermediate stenosis in 940 patients, in which the pullback maneuver confirmed PD ≤3 mmHg. The primary objectives were to determine the frequency and magnitude of PD and its effect on decision-making on the basis of an FFR cutoff of 0.80. In all, 479 (39.3%) measurements showed PD. PD was significantly associated with age, hypertension, reference diameter, left anterior descending artery lesion location, and read-out FFR values. Classification discordance between read-out and PD-corrected FFR values was detected in 44 (3.6%) measurements in total and in 9.2% of PD cases. The decision changed from FFR ≤0.80 to FFR >0.80 in 40 (3.3%) and vice versa in 4 (0.3%) measurements. PD showed no effect on decision-making when the FFR read-out value was ≤0.76 or ≥0.83.Conclusions:PD is not uncommon, and its effect on FFR-based decision-making was not negligible in the range between 0.77 and 0.82 where reclassification occurred in 18.7% of FFR measurements.