Angiography-based physiological assessment vs FFR for intermediate coronary lesions. A meta-analysis review

• Julio Ruiz ^[1] ; Carlos Cortés-Villar ^[1] ; Clara Fernández-Cordón ^[1] ; Mario García-Gómez ^[1] ; Adrián Lozano-Ibañez ^[1] ; David Carnicero-Martínez ^[1] ; Sara Blasco-Turrión ^[1] ; Manuel Carrasco-Moraleja ^[1] ; Pablo Marcos Canchaya ^[1] ; Diego Vegas Fernández ^[1] ; Ignacio Amat-Santos ^[1] ; José Alberto San Román-Calvar ^[1]
  1. [1] Hospital Clínico Universitario, Valladolid
• Localización: REC: Interventional Cardiology, ISSN-e 2604-7276, ISSN 2604-7306, Vol. 7, Nº. 3, 2025, pág. 206
• Idioma: inglés
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  • Introduction and objectives: Assessment and treatment of intermediate coronary lesions, defined as those which represent 30-90% of the vessel lumen, remains a clinical challenge. Physiological evaluation techniques as Fractional Flow Reserve, non-adenosine-based methods (such as iFR or RFR) and angiography derived physiological assessment techniques (ADPAT) have transformed the diagnostic landscape.

    This meta-analysis aims to systematically review and compare the diagnostic performance of ADPAT and FFR evaluating intermediate coronary lesions.

    Methods: From January to February 2024, a systematic review of comparative research on Fractional Flow Reserve (FFR) and ADPAT was performed. Twenty-seven studies were finally included in the meta-analysis after with a total of 4,818 patients and 5,440 vessels.

    Results: Overall, a strong correlation between the different ADPAT and FFR was observed (r = 0.83, 95% CI 0.80-0.85), with a mean ADPAT value of 0.82 (95% CI 0.81-0.83) and a mean FFR of 0.83 (95% CI 0.82-0.85). The summary AUC for predicting significant FFR (≤ 0.80) was excellent at 0.947. The overall sensitivity was 85% (95% CI 81%-87%) with a specificity of 93% (95% CI 91%-94%). The positive predictive value was 86% (95% CI 83%-88%) with a total negative predictive value of 92% (95% CI 91%-94%).

    Conclusions: ADPAT show good correlation and concordance with FFR for intermediate coronary lesion evaluation. However, due to unfavorable outcomes observed in the FAVOR III Europe1 trial with QFR-guided revascularization, its clinical role should be reconsidered and potentially limited to scenarios where invasive assessment or adenosine use is not feasible. Further evaluation is warranted to confirm its diagnostic performance in broader clinical contexts.