Pooled diagnostic accuracy of resting distal to aortic coronary pressure referenced to fractional flow reserve: The importance of resting coronary physiology.

摘要: INTRODUCTION Both resting and hyperemic physiologic methods to guide coronary revascularization improve cardiovascular outcomes compared with angiographic guidance alone. Fractional flow reserve (FFR) remains underutilized due concerns regarding hyperemia, prompting study of distal aortic pressure (Pd/Pa). Pd/Pa is a vasodilator-free index unlike FFR. While similar another index, instantaneous wave-free ratio (iFR), it whole-cycle measurement not limited the diastolic period. validated clinically although multiple accuracy studies have been performed. Our meta-analysis examines overall diagnostic referenced FFR, accepted invasive standard ischemia. METHODS We searched PubMed, EMBASE, Central, ProQuest, Web Science databases for full text articles published through August 9, 2017 addressing FFR < 0.80. The following keywords were used: "distal artery pressure" OR "Pd/Pa" AND "fractional reserve" "FFR." RESULTS In total, 14 comprising 7004 lesions identified. Pooled estimates versus FFR < 0.80 were: sensitivity, 0.77 (95% CI, 0.75-0.78); specificity, 0.82 (0.81-0.83); positive likelihood ratio, 4.7 (3.3-6.6); negative 0.29 (0.24-0.34); odds 18.1 (14.4-22.6); area under summary receiver-operating characteristic curve 0.88; 0.80 (0.76-0.83). CONCLUSIONS shows adequate agreement FFR as stenosis severity without undesired effects cost agents. has potential easier application availability iFR