Background: Fractional flow reserve (FFR) and non-hyperemic pressure ratios (NHPR) can show either marginal or definite discordance.
Objective: To investigate the clinical significance and factors associated with the magnitude of discordance between FFR and NHPR.
Methods: From the J-PRIDE registry, 4,304 lesions from 3,200 patients were categorized into six groups: (G1) definite FFR-/NHPR- (FFR≥0.82 and NHPR≥0.91), (G2) definite FFR+/NHPR+ (FFR≤0.78 and NHPR≤0.87), (G3) marginal discordant FFR+/NHPR- (FFR≤0.80 and NHPR=0.88-0.90, or FFR=0.79-0.81 and NHPR>0.89), (G4) definite discordant FFR+/NHPR- (FFR≤0.78 and NHPR≥0.91), (G5) marginal discordant FFR /NHPR+ (FFR=0.79-0.81 and NHPR≤0.89, or FFR>0.80 and NHPR=0.88-0.90), and (G6) definite discordant FFR-/NHPR+ (FFR≥0.82 and NHPR≤0.87). The study endpoint was the cumulative one-year incidence of major adverse cardiac events (MACE; all-cause mortality, myocardial infarction, and clinically driven revascularization).
Results: Compared with G1, groups with definite discordance exhibited higher risks of MACE (G4; adjusted hazard ratio [aHR]: 1.98; 95% confidence interval [CI]: 1.07–3.68; P=0.029; and G6; aHR: 2.18; 95%CI: 1.18–4.04; P=0.013), whereas those with marginal discordance (G3 and G5) did not. Additionally, G6 had an increased risk of all-cause mortality (aHR: 2.57; 95%CI: 1.19–5.56; P=0.017). In FFR+/NHPR- lesions, G3 and G4 showed divergent associations with the left anterior descending or left main coronary artery lesions and diameter stenosis. In FFR-/NHPR+ lesions, lower body mass index, diabetes mellitus, anemia, aortic stenosis, left ventricular hypertrophy, and in-stent restenosis were associated with G6, but not with G5.
Conclusions: Definite discordance between FFR and NHPR differs from marginal discordance in terms of clinical prognosis and associated factors.
Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC
CME Editor
Ragavendra R. Baliga, MD
Author
Shoichi Kuramitsu
Important Dates
Date of Release: August 10, 2026
Term of Approval/Date of CME/MOC Expiration: August 9, 2027