Age and functional relevance of coronary stenosis: A post hoc analysis of the ADVISE II trial

Daniel Candeias Faria, Joo Myung Lee, Tim Van Der Hoef, Hernán Mejía-Rentería, Mauro Echavarría-Pinto, Sérgio Bravo Baptista, Enrico Cerrato, Hector García-García, Justin Davies, Yoshinobu Onuma, Habib Samady, Jan J. Piek, Patrick W. Serruys, Amir Lerman, Javier Escaned*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)


Background: The influence of age-dependent changes on fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) and the response to pharmacological hyperaemia has not been investigated. Aims: We investigated the impact of age on these indices. Methods: This is a post hoc analysis of the ADVISE II trial, including a total of 690 pressure recordings (in 591 patients). Age-dependent correlations with FFR and iFR were calculated and adjusted for stenosis severity. Patients were stratified into three age terciles. The hyperaemic response to adenosine, calculated as the difference between resting and hyperaemic pressure ratios, and the prevalence of FFR-iFR discordance were assessed. Results: Age correlated positively with FFR (r=0.08, 95% CI: 0.01 to 0.15, p=0.015), but not with iFR (r=-0.03, 95% CI: -0.11 to 0.04, p=0.411). The hyperaemic response to adenosine decreased with patient age (0.12±0.07, 0.11±0.06, 0.09±0.05, for the 1st [33-58 years], 2nd [59-69 years] and 3rd [70-94 years] age tertiles, respectively, p<0.001) and showed significant correlation with age (r=-0.14, 95% CI: -0.21 to -0.06, p<0.001). The proportion of patients with FFR ≤0.80+iFR >0.89 discordance doubled in the first age tercile (14.1% vs 7.1% vs 7.0%, p=0.005). Conclusions: The hyperaemic response of the microcirculation to adenosine administration is age dependent. FFR values increase with patient age, while iFR values remain constant across the age spectrum. These findings contribute to explaining differences observed in functional stenosis classification with hyperaemic and non-hyperaemic coronary indices.

Original languageEnglish
Pages (from-to)757-764
Number of pages8
Issue number9
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
The ADVISE II study was funded by Volcano Corporation and all analysis was independently performed by the core laboratory (Cardialysis). The authors of this study are solely responsible for the design and conduct, all analysis, manuscript drafting and editing, and are responsible for its final contents.

Publisher Copyright:
© Europa Digital & Publishing 2021. All rights reserved.


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