Prognostic Impact of Definite and Marginal Discordance Between Fractional Flow Reserve and Nonhyperemic Pressure Ratio (JACC Cardiovascular Interventions August 2026)-Article: Prognostic Impact of Definite and Marginal Discordance Between Fractional Flow Reserve and Nonhyperemic Pressure Ratio

Pdf Summary

This post hoc analysis of the J-PRIDE registry examined whether the prognostic meaning of disagreement between fractional flow reserve (FFR) and nonhyperemic pressure ratio (NHPR) depends on how far the values are from their cutoff zones. Among 4,304 coronary lesions in 3,200 patients, lesions were classified as definite concordant, marginal discordant, or definite discordant based on borderline ranges around the usual thresholds.

The key finding was that <strong>definite discordance</strong> carried worse outcomes, while <strong>marginal discordance did not</strong>. Compared with definitively negative lesions (FFR–/NHPR–), both definite discordant groups had higher 1-year major adverse cardiac events (MACE): FFR/NHPR– lesions and FFR–/NHPR lesions. In contrast, marginal discordant lesions were not significantly different from concordantly negative lesions. The <strong>definite FFR–/NHPR group</strong> had the worst prognosis, with increased 1-year MACE and the only significant increase in all-cause mortality.

The study also found that the <strong>type of discordance reflected different clinical and anatomical patterns</strong>. Definite FFR/NHPR– discordance was associated with younger age, male sex, fewer diabetes/hemodialysis cases, and lesions in the LAD/left main territory. Definite FFR–/NHPR discordance was linked to older age, female sex, lower BMI, diabetes, hemodialysis, anemia, aortic stenosis, left ventricular hypertrophy, and in-stent restenosis.

Overall, the authors conclude that <strong>marginal discordance may often reflect measurement variability</strong>, whereas <strong>definite discordance likely represents true physiological or clinical abnormalities</strong> with prognostic significance. This suggests that combined interpretation of FFR and NHPR can improve risk stratification and may help identify patients who need closer follow-up or revascularization.

Meta Tag

Concept Fractional Flow Reserve

Concept Nonhyperemic Pressure Ratio

Concept Coronary Lesion

Concept Discordant Echocardiographic Severity Measures

Concept Major Adverse Cardiac Events

Keywords

fractional flow reserve

nonhyperemic pressure ratio

coronary lesions

post hoc analysis

J-PRIDE registry

discordance

major adverse cardiac events

prognosis

risk stratification

revascularization

Fractional Flow Reserve

Nonhyperemic Pressure Ratio

Coronary Lesion

Discordant Echocardiographic Severity Measures

Major Adverse Cardiac Events