APRIL 23e26, 2013

ORAL

ABSTRACTS

Previous studies showed correlation between anatomical parameters ofepicardial coronary stenosis and FFR. Nevertheless, the correlationbetween anatomical parameters and FFR has been either moderate orgood but with a large dispersion of FFR values for a similar angio-graphic degree of stenosis. The amount of myocardium supplied mightalso influence the FFR value. The dispersion may be partially related tothe pooling of both small and large supply area together in the samestudy cohort. However the impact of the supply area on the FFR valuehave not been adequately investigated yet. Thus the current study wasdesigned to assess the effect of the supply area on the functionalsignificance of coronary lesion.

Methods: A total of 296 lesions in 236 patients were assessed byquantitative coronary angiography and FFR. The supply area as percentageof left ventricle was estimated angiographically using amodified version ofthe Alberta Provivncia Project for OutcomeAssessment in Coronary HeartDisease (APPROACH) score (3.25 to 47.75%).

Results: FFR<0.75was seen in 93 (31.4%) of the overall 296 lesions.Therewas a positive correlation betweenminimal lumen diameter (MLD)and FFR (R¼0.584, p<0.001), and negative correlation between lesionlength and FFR (R¼-0.306, p<0.001), and between supply area (modi-fied APPROACH score) and FFR (R¼-0.408, p <0.001). The indepen-dent determinants of functionally significant stenosis based on FFR wereMLD (odds ratio [OR] 0.022; confidential interval [CI] 0.007-0.062;p<0.001), lesion length (OR 1.049; CI 1.020-1.079; p¼0.001), and thesupply area (OR 1.102; CI 1.068-1.137; p<0.001).

Conclusion: Not only the anatomical parameters of epicardial coro-nary stenosis but also its supply area affects the functional significance ofcoronary artery stenosis. Functional significance of coronary stenosisdepends on the balance of the lesion severity and its supply area.

- AS-109

Experience with FFR. Paramdeep Singh Sandhu, Upendra Kaul.Fortis Escorts Heart Institute and Research Centre, New Delhi, India.

Background: Fractional flow reserve (FFR) is a relatively recent toolto assess the functional significance of obstructive coronary lesions.Recent trials suggest that revascularization of moderate coronarystenoses can be safely deferred if the FFR is >0.80 and FFR can be usedto guide therapy in multivessel disease. We have evaluated theusefulness of this method in our setting in patients being taken for PCIfor multi vessel disease.

Methods: During the period May 2010 to August 2011, a total of203 patients (218 lesions were accessed (72%, males)) being taken upfor Percutaneous Coronary Intervention (PCI) were studied in thisongoing study. The lesions were assessed by three different observersand were divided on the basis of extent of occlusion ranging from 50%-70%, 71%-90%, 91%-99%.

FFRwas performed using the standard techniqueswithRadiAnalyzerXpress and Pressure wire Certus from St. Jude Medical. FFR wasmeasured with a coronary pressure guidewire at maximal hyperemiainduced by intravenous adenosine, which was administrated at a rate of140mcg per kilogram of bodyweight per minute through a central vein orintracoronary adenosine as a bolus starting from 60mcg upto 120mcg.FFR was calculated as the mean distal coronary pressure (measured withthe pressure wire) divided by the mean aortic pressure (measured simul-taneously by guiding catheter) duringmaximumhyperemia. A FFR valueof <0.80 identifies ischemia-causing coronary stenoses.

Results: A total of 203 patients (218 lesions) with 72% males beingtaken up for PCIwere studied.Of all the patients 41%were diabetics, 35%had hypertension and 10% had past history of myocardial infarction. Allpatients presentedwith chronic stable angina with 28% class 1, 29% class2, 24% class 3 and 19% were class 4. Coronary angiography revealedsingle vessel disease in 26%, double vessel disease in 53%while 21%hadtriple vessel disease.

52B The American Journal of Cardiology� APRIL

Number of patients in 50-70%, 71-90% and 91-99% narrowinggroups as assessed by 3 different observers were 136, 76 and 6 respec-tively, out of which 30, 38, 5 had FFR<0.80 in the respective groups. 73lesions (with a FFR � 0.80) out of total 218 lesions underwent revascu-larization and 145 lesions out of 218 lesions with a FFR> 0.80 were nottaken up for PCI. Overall, 66.5% of lesions avoided revascularization onthe basis of the FFR. The lesions with FFR� 0.80 were taken up for PCIand stenting.

Follow up of upto 2 years was done (mean 6.2 months). Totalnumber of MACE was 1 (TLR¼1)(0.012%) with no death, myocar-dial infarction, CABG or repeat PCI. Cost Effectiveness of FFR: Inthis study, 198 patients (212 lesions) were identified under 50%-90%Occlusion, if PCI would have been considered for all the lesions, then212 stents would have been used. By doing FFR, only 68 lesions werefound ischemic out of 212 Lesions. It means 144 lesions were notconsidered for PCI. FFR procedure will add Rs 30k per patient. For198 procedures¼5940000 Taking average cost per DES to be around1 lakh to the lesion: 212000000-5940000¼15260000 (1.526 Crores)73 patients (76 lesions) were identified under 70%- 90% Occlusion, ifPCI would have been considered for all the lesions, then 76 stentswould have been used. By doing FFR, only 38 lesions were foundischemic out of 76 Lesions. It means 38 lesions were not consideredfor PCIFFR procedure will add Rs. 30k per patient. For 73procedures¼2190000 Taking average cost per DES to be around1 lakh to the lesion: 7600000-2190000¼5410000 (54.10 lacs).Moreover, this cost includes only cost of stents and the savings willincrease when hospital stay, other hardware used during the procedurewill be taken into account.

Conclusion: Our ongoing study indicates that measurement of FFRis clinically useful with a high impact on clinical decision making in thecatheterization laboratory. FFR can be used to reclassify patients withmultivessel stenoses, reducing the need for revascularization in themajority of cases.

- AS-110

Fractional Flow Reserve: Intracoronary Versus IntravenousAdenosine Induced Maximal Coronary Hyperemia.Paramdeep Singh Sandhu, Upendra Kaul. Fortis Escorts HeartInstitute and Research Centre, New Delhi, India.

Background: Fractional Flow Reserve (FFR), a measure of coronarystenosis severity is based on achievement of maximal hyperemia ofcoronary microcirculation. The most widely used pharmacologicalagent is adenosine which is administered intravenously(IV). IVadenosine has more systemic side effects, is more time consumingand expensive as compared to intracoronary (IC) adenosine ina catheterization laboratory. Therefore this study was conducted tocompare IV versus IC adenosine for the achievement of maximalhyperemia.

Methods: FFR was assessed in 50 patients with 56 intermediatelesions using both IV and IC adenosine. IV adenosinewas administered asa continuous infusion at the rate of 140, 160 and 180 mcg/kg/min untila steady state hyperemia was achieved. IC adenosine boluses wereadministered at doses of 60, 100 and 120mcg. FFR was calculated as theratio of the distal coronary pressure to the aortic pressure at maximalhyperemia.

Results: A total of 25 left anterior descending, 8 right, 21 leftcircumflex, and 2 left main coronary arteries were evaluated. The meanpercent stenosis was 63.91.

Conclusion: This study suggests that IC adenosine is equivalent toIV infusion for the determination of FFR. The administration of ICadenosine is easy to use, cost effective, safe and associated with fewersystemic events.

23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Oral