Overview
Discordance between fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs) occurs in approximately 20% of cases, presenting a challenge for treatment decisions in the cardiac catheterization laboratory 1. This discordance refers to situations where physiological assessment of an intermediate coronary lesion yields conflicting results between FFR and NHPRs 1.Diagnosis
Discordance is identified when FFR and NHPRs provide differing assessments of an intermediate coronary lesion's hemodynamic significance 1.
Various NHPRs can be compared with FFR to assess for discordance 1.Management
Deferral of percutaneous coronary intervention (PCI) in patients with discordant physiology was associated with worse long-term outcomes compared to deferral in patients with concordant-negative physiology 1.
There may be a benefit of revascularization in cases of FFR-discordant physiology 1.Key Recommendations
Deferral of PCI in patients with discordant physiology is associated with worse long-term outcomes compared to deferral in patients with concordant-negative physiology 1. (Evidence: Moderate)
Revascularization may be beneficial in cases of FFR-discordant physiology 1. (Evidence: Weak)References
1 Ha ET, Nishi T, Takahashi T, Yamazaki T, Saito Y, Kuramitsu S et al.. Outcomes of Lesions With Discordance Between FFR and Nonhyperemic Pressure Ratios. JACC. Cardiovascular interventions 2025. link