CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 AFRICA 251 differences were found between the two groups (Table 2). In the non-critical stenosis group, the change in FFR value after adenosine infusion was greater in patients with multivessel disease than in those with single-vessel disease (p = 0.008), and in those with chronic total occlusion (CTO) (p = 0.037). In the Q3 group, this change was higher in those with critical stenosis (p = 0.001). In the non-critical stenosis group, this change was higher in those with a vessel diameter > 3 mm (p = 0.027). No significant difference was found in the other parameters (Table 3). Discussion The findings of this study suggest that (1) the baseline FFR value can be used to predict the presence of critical coronary stenosis and it can be accepted at a cut-off value of ≤ 0.92 with a sensitivity of 92.8% and a specificity of 82%; (2) according to the baseline FFR value, patients in the Q1 and Q2 groups were 58.4 times more likely to have critical coronary stenosis than patients in the Q3 and Q4 groups. In addition, the patients in the Q1 group had a 10.23 times greater likelihood of critical stenosis compared to those in the the Q2 group; (3) the baseline FFR value was similar in all the subgroups for predicting lesion severity, and it is appropriate to use the same cut-off value for different subgroups. FFR is the ratio of maximal blood flow to normal maximal flow in the stenosed coronary artery. It is used in the assessment of critical stenosis in the coronary arteries. It is measured as the ratio of the distal coronary pressure, obtained with a Table 2. Findings associated with critical FFR outcome after adenosine Variables Non-critical (n = 89) Critical (n = 69) p-value Age, years 60.3 ± 8.7 59.3 ± 9.7 0.512 Male gender, n (%) 68 (76.4) 56 (81.2) 0.560 Diabetes mellitus, n (%) 24 (27.0) 20 (29.0) 0.858 Hypertension, n (%) 28 (31.5) 33 (47.8) 0.036* Culprit lesion, n (%) LAD 54 (60.7) 61 (88.4) < 0.001* Cx 16 (18.0) 2 (2.9) RCA 17 (19.1) 6 (8.7) LMCA 1 (1.1) 0 D1 1 (1.1) 0 Segment, n (%) Ostial 22 (24.7) 23 (33.3) 0.430 Proximal 35 (39.3) 29 (42.0) Mid 30 (33.7) 16 (23.2) Distal 2 (2.2) 1 (1.4) Multivessel, n (%) 47 (52.8) 50 (72.5) 0.012* History of MI, n (%) 35 (39.3) 29 (42.0) 0.731 CTO, n (%) 3 (3.4) 7 (10.1) 0.160 FFR, % Baseline 94.7 ± 3.0 87.5 ± 3.6 < 0.001* Adenosine 88.8 ± 4.3 74.8 ± 4.0 < 0.001* Change 5.5 (3.3–8.2) 13 (10.7–16.7) < 0.001* Vessel diameter, n (%) < 3 mm 59 (66.3) 11 (15.9) < 0.001* > 3 mm 30 (33.7) 58 (84.1) Stent size, mm 2.9 (2.8–3) 3 (2.9–3) 0.554 Stent length, mm 18 (16–20) 28 (20–40) 0.171 GFR, ml/min/1.73 m2 83.3 ± 22.6 91.5 ± 18.8 0.068 Creatinine, mg/dl 0.9 (0.8–1.0) 0.8 (0.7–1.0) 0.335 Haemoglobin, g/dl 13.9 ± 2.0 13.6 ± 2.2 0.551 LVEDD, mm 46.8 ± 3.9 51.5 ± 5.1 0.025* LVESD, mm 31.1 ± 4.6 35.8 ± 6.1 0.096 LVEF, % 54.5 ± 9.8 51.6 ± 8.7 0.154 Data are presented as mean ± SD or median (IQR) or number (%). *p < 0.05 indicates statistical significance. LAD: left anterior descending, Cx: circumflex, RCA: right coronary artery, LMCA: left main coronary artery, D1: diagonal 1, MI: myocardial infarction, CTO: chronic total oclusion, FFR: fractionated flow reserve, GFR: glomerular filtration rate, LVEDD: left ventricular end-diastolic diameter, LVESD: left ventricular end-systolic diameter, LVEF: left ventricular ejection fraction. Table 3. Findings associated with change in FFR after adenosine Variables Change of FFR post adenosine Non-critical group p-value Critical group p-value Age r = –0.144 0.183 r = –0.120 0.327 Gender Female 5.3 (4.1–8.3) 0.858 15.1 (11.4–17.2) 0.420 Male 5.5 (3.2–8) 12.8 (10.3–16.6) Diabetes mellitus No 5.4 (3.2–8.2) 0.362 13 (11.2–16.3) 0.822 Yes 5.7 (4.2–8.3) 13.2 (10–19.7) Hypertension No 5.5 (3.3–7.8) 0.450 13.0 (10.2–16.2) 0.453 Yes 5.7 (3.7–8.9) 13.1 (11.9–16.9) Culprit vein LAD 6.3 (4.1–8.4) 0.800 13.1 (11.2–16.5) 0.208 Cx 5.7 (4.7–8.3) 9.7 (9.6–9.8) RCA 5.1 (3.3–7.3) 14.5 (12.1–17.2) Segment Ostial 5.3 (3.2–7.1) 0.684 15.7 (12.2–20.5) 0.156 Proximal 5.5 (3.2–8.7) 12.2 (9.8–16.7) Mid 5.4 (3.5–8.2) 12.6 (11–14.9) Distal 7.7 (6.1–9.4) 14.1 (14.1–14.1) Vessel Single 4.7 (3.1–6.7) 0.008* 12.2 (11.2–14.9) 0.224 Multivessel 6.5 (4.4–9.4) 14.1 (10.5–16.9) History of MI No 5.3 (3.2–7.3) 0.059 12.9 (11.0–16.6) 0.966 Yes 6.5 (4.4–8.7) 13.6 (10.5–16.7) CTO No 5.3 (3.3–7.8) 0.037* 13.4 (10.5–16.9) 0.655 Yes 9.4 (8.7–10.3) 12.5 (12.2–14.1) Baseline FFR Q1 4.0 (3.1–5.2) 0.496 11.8 (9.7–15.7) 0.001* Q2 5.5 (3.4–6.7) 14.6 (12.8–16.8) Q3 6.2 (3.6–7.8) 19.4 (15.0–21.5) Q4 5.2 (3.1–8.) - Vessel diameter < 3 mm 5.2 (3.2–7.4) 0.027* 12.2 (8.2–19.1) 0.241 > 3 mm 6.4 (4.3–11.1) 13.6 (11.4–16.7) Stent size, mm r = –0.100 0.958 r = –0.007 0.974 Stent length, mm r = –0.102 0.943 r = 0.090 0.669 GFR, ml/ min/1.73 m2 r = –0.045 0.789 r = 0.011 0.938 Creatinine, mg/dl r = 0.135 0.550 r = –0.003 0.983 Haemoglobin, g/dl r = –0.001 0.997 r = –0.134 0.359 LVEDD, mm r = 0.262 0.531 r = 0.151 0.536 LVESD, mm r = 0.072 0.878 r = 0.314 0.321 LVEF, % r = –0.21 0.212 r = –0.093 0.535 LAD: left anterior descending, Cx: circumflex, RCA: right coronary artery, MI: myocardial infarction, CTO: chronic total oclusion, FFR: fractionated flow reserve, GFR: glomerular filtration rate, LVEDD: left ventricular end-diastolic diameter, LVESD: left ventricular end-systolic diameter, LVEF: left ventricular ejection fraction.
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