Outcomes of Lesions with Discordance Between FFR and Non-Hyperemic Pressure Ratios Outcomes of Lesions with Discordance Between FFR and Non-Hyperemic Pressure Ratios (JACC Int July 2025)-Article: Outcomes of Lesions with Discordance Between FFR and Non-Hyperemic Pressure Ratios

Article: Outcomes of Lesions with Discordance Between FFR and Non-Hyperemic Pressure Ratios

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This meta-analysis examined long-term outcomes in patients with intermediate coronary lesions exhibiting discordance between fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs) to determine the safety of deferring percutaneous coronary intervention (PCI). Drawing data from six observational registries totaling 9,854 deferred lesions, the study compared outcomes of patients with discordant physiology patterns—either FFR ≤0.80 with negative NHPRs or FFR >0.80 with positive NHPRs—against those with concordant negative results (FFR >0.80 and negative NHPRs).<br /><br />Findings indicated that deferral of PCI in discordant lesions was associated with significantly worse long-term outcomes. Specifically, hazard ratios for the composite primary endpoint—which included death, myocardial infarction (MI), and revascularization—were notably elevated in both discordant groups compared to the concordant-negative cohort (HR 2.73 for FFR positive/NHPR negative; HR 3.29 for FFR negative/NHPR positive; both P <0.00001). Moreover, the risk of ‘hard’ endpoints (death or MI) was also increased in deferred discordant lesions. Sensitivity analyses confirmed the robustness of these results despite heterogeneity among included studies.<br /><br />Exploratory analyses suggested a possible benefit of revascularization in discordant lesions where FFR was ≤0.80 but NHPRs were negative, whereas no such benefit was observed when FFR was >0.80 but NHPRs positive. The authors propose that different discordant patterns may reflect distinct atherosclerotic lesion characteristics—focal versus diffuse disease—and thus may require tailored management approaches.<br /><br />Limitations include the observational nature of included studies, heterogeneity of NHPR indices used, and population differences mainly from East Asia and Europe, limiting generalizability. The study underscores the prognostic significance of discordant physiology in intermediate coronary lesions and calls for randomized controlled trials to determine optimal treatment strategies. This research highlights that deferring PCI in lesions with discordant FFR and NHPR measurements may expose patients to higher risks of adverse cardiac events, suggesting that revascularization decisions should consider these discordance patterns to improve clinical outcomes.

Keywords

fractional flow reserve

nonhyperemic pressure ratios

intermediate coronary lesions

discordant physiology

percutaneous coronary intervention

long-term outcomes

myocardial infarction

revascularization

hazard ratios

atherosclerotic lesion characteristics