Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Predicts Hemodynamic Outcome In Humans With Coronary Artery Disease

Kikuta, Yuetsu and Cook, Christopher M. and Sharp, Andrew S. P. and Salinas, Pablo and Kawase, Yoshiaki and Shiono, Yasutsugu and Giavarini, Alessandra and Nakayama, Masafumi and De Rosa, Salvatore and Sen, Sayan and Nijjer, Sukhjinder S. and Al-Lamee, Rasha and Petraco, Ricardo and Malik, Iqbal S. and Mikhail, Ghada W. and Kaprielian, Raffi R. and Wijntjens, Gilbert W. M. and Mori, Shinsuke and Hagikura, Arata and Mates, Martin and Mizuno, Atsushi and Hellig, Farrel and Lee, Kelvin and Janssens, Luc and Horie, Kazunori and Mohdnazri, Shah R. and Herrera, Raul and Krackhardt, Florian and Yamawaki, Masahiro and Davies, John R. and Takebayashi, Hideo and Keeble, Thomas R. and Haruta, Seiichi and Ribichini, Flavio and Indolfi, Ciro and Mayet, Jamil and Francis, Darrel P. and Piek, Jan J. and Di Mario, Carlo and Escaned, Javier and Matsuo, Hitoshi and Davies, Justin E. (2018) Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Predicts Hemodynamic Outcome In Humans With Coronary Artery Disease. JACC: Cardiovascular Interventions, 11 (8). pp. 757-767. ISSN 1876-7605

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OBJECTIVES: The authors sought to evaluate the accuracy of instantaneous wave-Free Ratio (iFR) pullback measurements to predict post-percutaneous coronary intervention (PCI) physiological outcomes, and to quantify how often iFR pullback alters PCI strategy in real-world clinical settings. BACKGROUND: In tandem and diffuse disease, offline analysis of continuous iFR pullback measurement has previously been demonstrated to accurately predict the physiological outcome of revascularization. However, the accuracy of the online analysis approach (iFR pullback) remains untested. METHODS: Angiographically intermediate tandem and/or diffuse lesions were entered into the international, multi-center iFR GRADIENT (Single instantaneous wave-Free Ratio Pullback Pre-Angioplasty Predicts Hemodynamic Outcome Without Wedge Pressure in Human Coronary Artery Disease) registry. Operators were asked to submit their procedural strategy after angiography alone and then after iFR-pullback measurement incorporating virtual PCI and post-PCI iFR prediction. PCI was performed according to standard clinical practice. Following PCI, repeat iFR assessment was performed and the actual versus predicted post-PCI iFR values compared. RESULTS: Mean age was 67+/-12 years (81% male). Paired pre-and post-PCI iFR were measured in 128 patients (134 vessels). The predicted post-PCI iFR calculated online was 0.93+/-0.05; observed actual iFR was 0.92+/-0.06. iFR pullback predicted the post-PCI iFR outcome with 1.4+/-0.5% error. In comparison to angiography-based decision making, after iFR pullback, decision making was changed in 52 (31%) of vessels; with a reduction in lesion number (-0.18+/-0.05 lesion/vessel; p = 0.0001) and length (-4.4+/-1.0 mm/vessel; p < 0.0001). CONCLUSIONS: In tandem and diffuse coronary disease, iFR pullback predicted the physiological outcome of PCI with a high degree of accuracy. Compared with angiography alone, availability of iFR pullback altered revascularization procedural planning in nearly one-third of patients.

Item Type: Journal Article
Keywords: coronary artery disease, instantaneous wave-Free Ratio, physiological lesion assessment, stenosis
Faculty: ARCHIVED Faculty of Medical Science (until September 2018)
Depositing User: Ian Walker
Date Deposited: 29 May 2018 11:19
Last Modified: 09 Sep 2021 18:57

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