| 양형모, 탁승제, 임홍석, 윤명호, 최병주,최소연, 김진우, 서경우, 한은진,김선미, 조대열,김웅걸, 박진선, 황교승, 신준한 |
Backgrounds: The fractional flow reserve (FFR) value between 0.75 and 0.80 has been established as a borderline. Revascularization of borderline FFR is controversial and it is not well known for morphologic characteristics of borderline FFR lesion. The objective of this study is to find out intravascular ultrasound (IVUS) characteristics in intermediate coronary lesions with borderline FFR.
Methods: Patients with intermediate coronary artery stenosis (40-70% diameter stenosis) were enrolled. Both IVUS and FFR were performed in 137 left anterior descending artery (LAD). We divided lesions into 3 groups according to FFR value; ischemic (IS, n=16, FFR < 0.75), borderline (BD, n=36, 0.75≤ FFR <0.80) and non-ischemic (NI, n=85, FFR ≥0.80). We compared IVUS parameters including minimal lumen area, lesion length, plaque burden and volumetric parameters among 3 groups.
Results: There was no significant difference in reference vessel diameter among 3 groups. Diameter stenosis is more severe (63.2±8.0 vs 58.3±8.5 vs 52.4±8.3%, p<0.001) and minimal luminal diameter is smaller (1.2±0.3 vs 1.4±0.3 vs 1.6±0.3 mm, p<0.001) in IS and BD group than NI group, respectively. On IVUS analysis, minimal lumen area is smaller (2.33±0.74 vs 2.61±0.65 vs 3.61±1.66 mm2, p<0.001), IVUS lesion length is longer (27.3±9.9 vs 26.9±7.6 vs 17.8±7.2 mm, p<0.001), plaque burden is larger (79.7±7.6 vs 74.7±7.3 vs 69.9±9.4 %, p<0.001), plaque volume is larger (207.1±89.9 vs 195.0±79.6 vs 134.4±83.6 mm3, p<0.001) and percent atheroma volume is larger (61.4±5.8 vs 59.2±5.1 vs 54.5±8.0%, p<0.001) in IS and BD group than NI group, respectively. However, post-hoc analyses showed there were no significant differences between IS and BD group in all IVUS parameters.
Conclusions: In intermediate coronary lesions, there were no differences in IVUS characteristics between borderline and functionally significant FFR, but the stenosis and amount of atheromatous plaque are more severe in these 2 groups than non-ischemic lesions with FFR≥0.80. FFR cut-off point of 0.80 seems to be appropriate criteria for coronary revascularization in intermediate lesion of LAD.
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