FIRST: Fractional Flow Reserve and Intravascular Ultrasound Relationship Study.
FIRST: Fractional Flow Reserve and Intravascular Ultrasound Relationship Study.
- 2013
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: FFR is considered the gold standard for assessing intermediate coronary lesions. Measurements of <=0.8 are considered clinically significant and indicative of physiological ischemia. CONCLUSIONS: Anatomic measurements by IVUS show a moderate correlation with the FFR values. The optimal cutoff for an MLA to FFR <0.8 is vessel dependent. Plaque morphology characteristics do not correlate with FFR. The utility of IVUS MLA as an alternative to FFR to guide intervention in intermediate lesions may be limited in accuracy and should be tested clinically. (Fractional Flow Reserve and Intravascular Ultrasound Relationship Study [FIRST]; NCT01153555). Copyright 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: FIRST is a multicenter, prospective, international registry of patients with intermediate coronary lesions, defined as 40% to 80% stenosis by angiography. In total, 350 patients (367 lesions) were enrolled at 10 U.S. and European sites. Patients were followed through hospital discharge. OBJECTIVES: FIRST (Fractional Flow Reserve and Intravascular Ultrasound Relationship Study) aimed to determine the optimal minimum lumen area (MLA) by intravascular ultrasound (IVUS) that correlates with fractional flow reserve (FFR) and to assess the correlation between virtual histology IVUS and FFR for intermediate coronary lesions. RESULTS: Overall, an MLA <3.07 mm (64.0% sensitivity, 64.9% specificity, area under curve [AUC] = 0.65) was the best threshold value for identifying FFR <0.8. The accuracy improved when reference vessel-specific analyses were performed. An MLA <2.4 mm (AUC = 0.66) was best for reference vessel diameters <3.0 mm, an MLA <2.7 mm (AUC = 0.71) for reference vessel diameters of 3.0 to 3.5 mm, and an MLA <3.6 mm (AUC = 0.68) for reference vessel diameters >3.5 mm. FFR correlated with plaque burden (r = -0.220, p < 0.001) but not with other plaque morphology.
English
0735-1097
*Coronary Disease/di [Diagnosis]
*Fractional Flow Reserve, Myocardial/ph [Physiology]
*Ultrasonography, Interventional
Coronary Angiography
Female
Humans
Male
Middle Aged
Prospective Studies
Registries
MedStar Health Research Institute
MedStar Heart & Vascular Institute
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: FFR is considered the gold standard for assessing intermediate coronary lesions. Measurements of <=0.8 are considered clinically significant and indicative of physiological ischemia. CONCLUSIONS: Anatomic measurements by IVUS show a moderate correlation with the FFR values. The optimal cutoff for an MLA to FFR <0.8 is vessel dependent. Plaque morphology characteristics do not correlate with FFR. The utility of IVUS MLA as an alternative to FFR to guide intervention in intermediate lesions may be limited in accuracy and should be tested clinically. (Fractional Flow Reserve and Intravascular Ultrasound Relationship Study [FIRST]; NCT01153555). Copyright 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: FIRST is a multicenter, prospective, international registry of patients with intermediate coronary lesions, defined as 40% to 80% stenosis by angiography. In total, 350 patients (367 lesions) were enrolled at 10 U.S. and European sites. Patients were followed through hospital discharge. OBJECTIVES: FIRST (Fractional Flow Reserve and Intravascular Ultrasound Relationship Study) aimed to determine the optimal minimum lumen area (MLA) by intravascular ultrasound (IVUS) that correlates with fractional flow reserve (FFR) and to assess the correlation between virtual histology IVUS and FFR for intermediate coronary lesions. RESULTS: Overall, an MLA <3.07 mm (64.0% sensitivity, 64.9% specificity, area under curve [AUC] = 0.65) was the best threshold value for identifying FFR <0.8. The accuracy improved when reference vessel-specific analyses were performed. An MLA <2.4 mm (AUC = 0.66) was best for reference vessel diameters <3.0 mm, an MLA <2.7 mm (AUC = 0.71) for reference vessel diameters of 3.0 to 3.5 mm, and an MLA <3.6 mm (AUC = 0.68) for reference vessel diameters >3.5 mm. FFR correlated with plaque burden (r = -0.220, p < 0.001) but not with other plaque morphology.
English
0735-1097
*Coronary Disease/di [Diagnosis]
*Fractional Flow Reserve, Myocardial/ph [Physiology]
*Ultrasonography, Interventional
Coronary Angiography
Female
Humans
Male
Middle Aged
Prospective Studies
Registries
MedStar Health Research Institute
MedStar Heart & Vascular Institute
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't