Prevalence and Clinical Outcomes of Discordant Lesions Between Fractional Flow Reserve and Nonhyperemic Pressure Ratios in Clinical Practice: The J-PRIDE Registry.
Summary
In 4304 lesions, FFR–NHPR discordance occurred in 20%. Deferred discordant lesions had higher 1-year target vessel failure than concordant negative lesions. Notably, only FFR+/NHPR− lesions derived benefit from revascularization versus medical therapy, supporting FFR-guided decisions when indices disagree.
Key Findings
- FFR–NHPR discordance was present in 20% of lesions (FFR+/NHPR− 11.2%; FFR−/NHPR+ 8.8%).
- Deferred discordant lesions had higher 1-year target vessel failure vs concordant negative (7.9% and 5.5% vs 1.7%).
- Only FFR+/NHPR− lesions showed benefit from revascularization over medical therapy.
Clinical Implications
When FFR and NHPR disagree, consider revascularization for FFR-positive/NHPR-negative lesions and be cautious deferring such lesions. Concordant negative lesions remain safe to defer.
Why It Matters
Provides high-quality prospective real-world evidence resolving a common clinical dilemma in physiology-guided PCI, with actionable guidance favoring FFR when indices disagree.
Limitations
- Observational design with potential residual confounding and selection bias in deferral decisions
- Generalizability may vary by NHPR type and center practices
Future Directions
Randomized trials in discordant lesions testing FFR- vs NHPR-guided strategies; standardized protocols across NHPR modalities.
Study Information
- Study Type
- Cohort
- Research Domain
- Diagnosis
- Evidence Level
- II - Prospective multicenter observational registry with adjusted analyses
- Study Design
- OTHER