Relationship Between Pressure-Derived Physiologic Indices and Inducible Myocardial Ischemia During the Adenosine Stress Test

We evaluated the relationship between pressure-derived physiologic indices and inducible myocardial ischemia (IMI), defined by significant ST-segment changes during adenosine stress testing, in 227 patients with left main or left anterior descending coronary artery disease. Associations with symptomatic improvement, assessed by the 7-item Seattle Angina Questionnaire at 1 month post-PCI, were also analyzed. Optimal cut-off values for IMI were lower than current thresholds, with the instantaneous wavefree ratio (iFR) showing superior diagnostic accuracy (higher AUC) compared to other indices. PCI provided the greatest symptomatic relief in patients with moderate-to-severe angina and concomitant IMI. In conclusion, iFR more accurately identifies IMI, and PCI benefits are most pronounced in patients with IMI-related chest pain.