Functional results of percutaneous coronary intervention (PCI) were found to be predicted by pre-PCI nonhyperemic pressure ratios (NHPRs), according to a prospective, multicenter, randomized controlled trial, published in the Journal of the American College of Cardiologist: Cardiovascular Interventions.

A total of 140 patients (mean age, 71±10 years; 77% men; 66.7% with left anterior descending coronary artery lesions) with coronary artery disease who had 40% to 90% stenosis and NHPRs £0.89 in major epicardial vessels were recruited at 3 centers in Japan between 2018 and 2019. Vessels (N=150) were randomly assigned at a 1:1:1 ratio to be assessed using instantaneous wave-free ratio (iFR; 50 vessels in 46 patients), resting full-cycle ratio (RFR; 50 vessels in 49 patients), or diastolic pressure ratio (dPR; 50 vessels in 45 patients). NHPRs and clinical outcomes were assessed pre- and post-PCI. All 3 groups had comparable baseline characteristics and PCI procedural data.

The majority of PCI procedures were optimized using intravascular ultrasound (90.7%) and dilated with noncompliant balloons (84.7%).

Pre-PCI predictions were found to be highly correlated with post-PCI NHPR observations (iFR: r, 0.83; 95% CI, 0.72-0.90; P <.001; RFR: r, 0.84; 95% CI, 0.73-0.91; P <.001; dPR: r, 0.84; 95% CI, 0.73-0.91; P <.001). NHPRs predicted prior to PCI vs actual post-procedural NHPRs had the following agreements: iFR: 0.02 (limits of agreement, -0.04 to 0.07); RFR: 0.01 (limits of agreement, -0.03 to 0.07); and dPR: 0.02 (limits of agreement, -0.03 to 0.07).


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The number of lesions and total length of lesions were reduced when NHPRs were used vs angiography-guided strategy: number of lesions: iFR, P =.009; RFR, P =.002; and dPR, P =.007; length of lesions: iFR, P =.007; RFR, P =.003; dPR, P =.012). The number and total length of lesions were poorly correlated between angiography-guided and NHPR pull back-guided methods (r, -0.22; 95% CI, -0.37 to -0.07 and r, -0.24; 95% CI, -0.38 to -0.07, respectively)

Study limitations include the absence of a comparison between manual and motorized pull back methods, and the lack of assessment of longer-term clinical outcomes with the NHPR pull-back strategies.

These data indicated that all NHPR pull back-guided strategies for the treatment of lesions in patients with stable coronary artery disease were able to reduce the number and total length of treated lesions and that pre-PCI predictions were highly correlated with post-PCI observations after revascularization.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Omori H, Kawase Y, Mizukami T, et al. Comparisons of nonhyperemic pressure ratios. Predicting functional results of coronary revascularization using longitudinal vessel interrogation. JACC Cardiovasc Interv. 2020;S1936-8798(20)31476-X. doi:10.1016/j.jcin.2020.06.060