Stenosis morphology and<br>functional significance<br>Coronary artery stenosis characteristics<br>and fractional flow reserve<br>The FFR and Intravascular Ultrasound Relationship Study (FIRST)<br>was a prospective, multicentre, international registry of 350 patients<br>[367 lesions; 55% stable angina, 42% acute coronary syndrome<br>(ACS)] that assessed the relationships between coronary lesion<br>characteristics revealed by intravascular ultrasound (IVUS) and<br>FFR.34 A minimum lumen area (MLA) of ,3.07 mm2 had moderate<br>accuracy [area-under-the curve (AUC) ¼ 0.65] for identifying an<br>FFR of ,0.80, and the AUC increased with increasing vessel diameter (a surrogate for subtended myocardial volume). Plaque burden<br>had a weak positive correlation with FFR (r ¼ 20.22, P , 0.001).<br>Thin-cap fibroatheroma and calcification were associated with lower correlations between MLA and FFR. The multivariable correlates<br>of FFR were MLA by IVUS, diameter stenosis by QCA, and left anterior descending (LAD) coronary artery (vs. right coronary artery).<br>Iguchi et al.<br>35 found a strong inverse correlation between lesion<br>length and FFR value. Lo´pez-Palop et al.<br>36 suggested that a length<br>of .20 mm was the strongest morphological determinant of functional significance. Takashima et al.<br>37 found that lesion complexity<br>(assessed by QCA) correlated with FFR, with the hypothesis that<br>with increasing complexity there are greater pressure losses due<br>to flow separation and friction. In a multivariate analysis, Cho
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