TY - JOUR
T1 - Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Predicts Hemodynamic Outcome In Humans With Coronary Artery Disease: Primary Results of the International Multicenter iFR GRADIENT Registry
AU - Kikuta, Yuetsu
AU - Cook, Christopher M.
AU - Sharp, Andrew S. P.
AU - Salinas, Pablo
AU - Kawase, Yoshiaki
AU - Shiono, Yasutsugu
AU - Giavarini, Alessandra
AU - Nakayama, Masafumi
AU - de Rosa, Salvatore
AU - Sen, Sayan
AU - Nijjer, Sukhjinder S.
AU - Al-Lamee, Rasha
AU - Petraco, Ricardo
AU - Malik, Iqbal S.
AU - Mikhail, Ghada W.
AU - Kaprielian, Raffi R.
AU - Wijntjens, Gilbert W. M.
AU - Mori, Shinsuke
AU - Hagikura, Arata
AU - Mates, Martin
AU - Mizuno, Atsushi
AU - Hellig, Farrel
AU - Lee, Kelvin
AU - Janssens, Luc
AU - Horie, Kazunori
AU - Mohdnazri, Shah
AU - Herrera, Raul
AU - Krackhardt, Florian
AU - Yamawaki, Masahiro
AU - Davies, John
AU - Takebayashi, Hideo
AU - Keeble, Thomas
AU - Haruta, Seiichi
AU - Ribichini, Flavio
AU - Indolfi, Ciro
AU - Mayet, Jamil
AU - Francis, Darrel P.
AU - Piek, Jan J.
AU - di Mario, Carlo
AU - Escaned, Javier
AU - Matsuo, Hitoshi
AU - Davies, Justin E.
PY - 2018
Y1 - 2018
N2 - 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, multicenter 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.
AB - 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, multicenter 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85045221623&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29673507
U2 - https://doi.org/10.1016/j.jcin.2018.03.005
DO - https://doi.org/10.1016/j.jcin.2018.03.005
M3 - Article
C2 - 29673507
SN - 1936-8798
VL - 11
SP - 757
EP - 767
JO - JACC. Cardiovascular interventions
JF - JACC. Cardiovascular interventions
IS - 8
ER -