Impact of Sex Difference on the Discordance of Revascularization Decision Making Between Fractional Flow Reserve and Diastolic Pressure Ratio During the Wave‐Free Period

BACKGROUND: Sex difference in fractional flow reserve (FFR) and resting index has not been fully clarified. We sought to investigate the impact of sex on the discordance of revascularization decision making between FFR and diastolic pressure ratio during the diastolic wave‐free period (dPR(WFP)). METHODS AND RESULTS: A total of 759 angiographically intermediate lesions with 30% to 80% diameter stenosis by quantitative coronary angiography in 577 patients in whom FFR and dPR(WFP) were measured were investigated. dPR(WFP) was measured during the wave‐free window of 5 heart cycles at an independent core laboratory. FFR ≤0.80 and dPR(WFP) ≤0.89 were considered positive studies. A total of 164 vessels in 126 women (21.6%) and 595 vessels in 451 men (78.4%) were included. In lesions with negative dPR(WFP), positive FFR was less frequently observed in women (13 of 73; 17.8%) than in men (97 of 286; 33.9%) (P=0.009). In lesions with positive dPR(WFP), the frequency of negative FFR was observed in 22 of 91 vessels (24.2%) in women and 51 of 309 vessels (16.5%) in men, which did not reach statistical significance (P=0.098). In multivariable analyses, female sex was independently associated with FFR‐dPR(WFP) discordance both in negative dPR(WFP) cohort (odds ratio, 0.44; 95% CI, 0.21–0.98; P=0.036) and in positive dPR(WFP) cohort (odds ratio, 2.41; 95% CI, 1.17–4.96; P=0.017) after adjustment for age, weight, quantitative coronary angiography data, and baseline physiological indexes. CONCLUSIONS: The frequency of FFR‐dPR(WFP) discordance was significantly associated with sex, which may indicate potential shift of optimal threshold of either FFR or dPR(WFP), or both of them, according to sex.