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Open Heart. 2019 Mar 25;6(1):e000971. doi: 10.1136/openhrt-2018-000971. eCollection 2019.

Fractional flow reserve derived from microcatheters versus standard pressure wires: a stenosis-level meta-analysis.

Author information

1
International Centre for Circulatory Health, Imperial College London, London, UK.
2
Department of Medicine, Imperial College Healthcare NHS Trust, London, UK.
3
Cardiology, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil.

Abstract

Aims:

To determine the agreement between sensor-tipped microcatheter (MC) and pressure wire (PW)-derived fractional flow reserve (FFR).

Methods and results:

Studies comparing FFR obtained from MC (FFRMC, Navvus Microcatheter System, ACIST Medical Systems, Eden Prairie, Minnesota, USA) versus standard PW (FFRPW) were identified, and a meta-analysis of numerical and categorical agreement was performed. The relative levels of drift and device failure of MC and PW systems from each study were assessed. Six studies with 440 lesions (413 patients) were included. The mean overall bias between FFRMC and FFRPW was -0.029 (FFRMC lower). Bias and variance were greater for lesions with lower FFRPW (p<0.001). Using a cut-off of 0.80, 18 % of lesions were reclassified by FFRMC versus FFRPW (with 15 % being false positives). The difference in reported drift between FFRPW and FFRMC was small. Device failure was more common with MC than PW (7.1% vs 2%).

Conclusion:

FFRMC systematically overestimates lesion severity, with increased bias in more severe lesions. Using FFRMC changes revascularisation guidance in approximately one out of every five cases. PW drift was similar between systems. Device failure was higher with MC.

KEYWORDS:

coronary angiography; coronary physiology; coronary stenting; fractional flow reserve

Conflict of interest statement

Competing interests: Drs Cook, Al-Lamee and Nijjer have conducted teaching sessions supported by Volcano Corporation. Dr Petraco is a consultant for Philips Volcano. Dr Davies is a consultant for and has received research funding from Philips Volcano. Dr Sen has attended and conducted teaching sessions supported by Volcano Corporation, St. Jude Medical, Medtronic, Pfizer and AstraZeneca. Dr Chamie has acted as a consultant to Abott Vascular inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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