Fractional flow reserve and pressure-bounded coronary flow reserve to predict outcomes in coronary artery disease

Jung Min Ahn, Frederik M. Zimmermann, Nils P. Johnson, Eun Seok Shin, Bon Kwon Koo, Pil Hyung Lee, Duk Woo Park, Soo Jin Kang, Seung Whan Lee, Young Hak Kim, Cheol Whan Lee, Seong Wook Park, Nico H.J. Pijls, Seung Jung Park

Research output: Contribution to journalArticleAcademicpeer-review

20 Citations (Scopus)


Aims Fractional flow reserve (FFR) has proven to its prognostic and therapeutic value. However, the additive prognostic value of coronary flow reserve (CFR) remains unclear. This study sought to investigate the clinical utility of combined FFR and CFR measurements to predict outcomes. Methods and results Using the prospective, multicentre Interventional Cardiology Research Incooperation Society-FFR registry, a total of 2088 lesions from 1837 patients were included in this substudy. Based on baseline and hyperaemic pressure gradients, we computed physiologic limits of CFR [the so called pressure-bounded (pb) CFR] and classified lesions as low (<2) or high (≥2). The primary endpoint was major adverse cardiac events (MACE, a composite of cardiac death, myocardial infarction, and revascularization) analysed on a per-patient basis. During a median follow-up of 1.9 years (inter-quartile range: 1.0-3.0 years), MACE occurred in 5.7% of patients with FFR ≤0.80 vs. 2.8% of patients with FFR >0.80 [adjusted hazard ratio (aHR): 2.15, 95% confidence interval (CI): 1.19-3.89; P = 0.011. In contrast, the incidence of MACE did not differ between patients with pb-CFR < 2 vs. pb-CFR ≥ 2 (4.2% vs. 4.2%; aHR: 0.98, CI: 0.60 to 1.58; P = 0.92). Incorporation of FFR significantly improved model prediction of MACE (global - ‡ 2 38.8-48.1, P = 0.002). However, pb-CFR demonstrated no incremental utility to classify outcomes (global ‡ 2 48.1-48.2, P > 0.99). Conclusions In this large, prospective registry of over 2000 coronary lesions, FFR was strongly associated with clinical outcomes. In contrast, a significant association between pb-CFR and clinical events could not be determined and adding knowledge of pb-CFR did not improve prognostication over FFR alone.

Original languageEnglish
Pages (from-to)1980-1989
Number of pages10
JournalEuropean Heart Journal
Issue number25
Publication statusPublished - 1 Jul 2017


  • Coronary artery disease
  • Coronary flow reserve
  • Fractional flow reserve
  • Prognosis
  • Blood Pressure/physiology
  • Prospective Studies
  • Myocardial Revascularization/mortality
  • Humans
  • Middle Aged
  • Male
  • Treatment Outcome
  • Myocardial Infarction/etiology
  • Percutaneous Coronary Intervention/mortality
  • Fractional Flow Reserve, Myocardial/physiology
  • Coronary Stenosis/physiopathology
  • Hyperemia/mortality
  • Postoperative Complications/mortality
  • Female
  • Registries
  • Aged


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