Routine Pressure Wire Assessment at Time of Diagnostic Angiography

Belle, Éric Van; Rioufol, Gilles; Dupouy, Patrick

doi:10.1161/circinterventions.114.001415

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…In the setting of randomized trials, the combination of protocol-mandated procedures and highly selective inclusion and exclusion criteria frequently narrows their applicability to daily real-word practice. 26,27 In the particular case of the present prospective study, we were able to expand to a specific population with ACS the findings from previous nonrandomized prospective studies, such as the RIPCORD study (Does Routine Pressure Wire Assessment Influence Management Strategy at Coronary Angiography for Diagnosis of Chest Pain), the R3F, and the POST-IT studies, namely, the potential of routine use of FFR for management reclassification and the safety of lesion deferral. These findings were further supported by extensive multivariable analyses.…”

Section: Study Limitationsmentioning

confidence: 88%

“…Furthermore, this study extends to the ACS population, the previous observation made in the general populations of R3F, RIPCORD, and POST-IT, 5,6,17 that the ultimate effect of routine FFR at time of angiography is not to decrease the number of patients referred to revascularization, but rather to deliver the appropriate treatment to each individual patient. 26,27 However, large randomized trials, powered for clinical outcomes, are needed to further refine the role of FFR and of new physiological indexes, independent of inducible hyperemia, on patient management in this setting. Both the DEFINE-FLAIR 29 (Use of the Instantaneous Wave-Free Ratio or Fractional Flow Reserve in PCI) and iFR-SWEDEHEART 30 (Evaluation of iFR vs FFR in Stable Angina or Acute Coronary Syndrome) randomized studies-which compared FFR-with iFR-guided treatment of obstructive CAD-have included ≈20% and 38% of patients with ACS, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Routine Fractional Flow Reserve on Management Decision and 1-Year Clinical Outcome of Patients With Acute Coronary Syndromes

Belle

Baptista

Raposo

et al. 2017

Circ: Cardiovascular Interventions

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Background— Fractional flow reserve (FFR) is not firmly established as a guide to treatment in patients with acute coronary syndromes (ACS). Primary goals were to evaluate the impact of integrating FFR on management decisions and on clinical outcome of patients with ACS undergoing coronary angiography, as compared with patients with stable coronary artery disease. Methods and Results— R3F (French FFR Registry) and POST-IT (Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease), sharing a common design, were pooled as PRIME-FFR (Insights From the POST-IT and R3F Integrated Multicenter Registries - Implementation of FFR in Routine Practice). Investigators prospectively defined management strategy based on angiography before performing FFR. Final decision after FFR and 1-year clinical outcome were recorded. From 1983 patients, in whom FFR was prospectively used to guide treatment, 533 sustained ACS (excluding acute ST-segment–elevation myocardial infarction). In ACS, FFR was performed in 1.4 lesions per patient, mostly in left anterior descending (58%), with a mean percent stenosis of 58±12% and a mean FFR of 0.82±0.09. In patients with ACS, reclassification by FFR was high and similar to those with non-ACS (38% versus 39%; P =NS). The pattern of reclassification was different, however, with less patients with ACS reclassified from revascularization to medical treatment compared with those with non-ACS ( P =0.01). In ACS, 1-year outcome of patients reclassified based on FFR (FFR against angiography) was as good as that of nonreclassified patients (FFR concordant with angiography), with no difference in major cardiovascular event (8.0% versus 11.6%; P =0.20) or symptoms (92.3% versus 94.8% angina free; P =0.25). Moreover, FFR-based deferral to medical treatment was as safe in patients with ACS as in patients with non-ACS (major cardiovascular event, 8.0% versus 8.5%; P =0.83; revascularization, 3.8% versus 5.9%; P =0.24; and freedom from angina, 93.6% versus 90.2%; P =0.35). These findings were confirmed in ACS explored at the culprit lesion. In patients (6%) in whom the information derived from FFR was disregarded, a dire outcome was observed. Conclusions— Routine integration of FFR into the decision-making process of ACS patients with obstructive coronary artery disease is associated with a high reclassification rate of treatment (38%). A management strategy guided by FFR, divergent from that suggested by angiography, including revascularization deferral, is safe in ACS.

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Section: Study Limitationsmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Impact of Routine Fractional Flow Reserve on Management Decision and 1-Year Clinical Outcome of Patients With Acute Coronary Syndromes

Belle

Baptista

Raposo

et al. 2017

Circ: Cardiovascular Interventions

Self Cite

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show abstract

“…It also gave us the opportunity to discuss several aspects of the concept and to further elaborate on its benefits. 3 In short, this new diagnostic concept proposes to combine diagnostic angiography and FFR as a single one-stop procedure and intend to make it the ultimate tool for clinical decision making in patients suspected of coronary artery disease. The key benefit of such an approach is to allow to discharge the patient from the catheterization laboratory with a clear, detailed, and definitive therapeutic plan.…”

mentioning

confidence: 99%

Routine Fractional Flow Reserve Combined to Diagnostic Coronary Angiography as a One-Stop Procedure

Belle

Dupouy

Rioufol

2016

Circ: Cardiovascular Interventions

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“…Patient outcomes are superior to angiography alone when FFR is used to guide intervention in stable coronary disease [1] and have recently been proposed to re-classify treatment strategies in more than a quarter of stable patients referred for diagnostic angiography [2], prompting suggestions that FFR might conceivably come to be used during diagnostic coronary angiography in a "routine" manner [3].…”

mentioning

confidence: 99%

When it comes down to the wire: Iatrogenic coronary lesion disruption due to passage of a pressure wire

Bing

Khoury

Lowe

2014

International Journal of Cardiology

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Routine Pressure Wire Assessment at Time of Diagnostic Angiography

Cited by 6 publications

References 11 publications

Impact of Routine Fractional Flow Reserve on Management Decision and 1-Year Clinical Outcome of Patients With Acute Coronary Syndromes

Impact of Routine Fractional Flow Reserve on Management Decision and 1-Year Clinical Outcome of Patients With Acute Coronary Syndromes

Routine Fractional Flow Reserve Combined to Diagnostic Coronary Angiography as a One-Stop Procedure

When it comes down to the wire: Iatrogenic coronary lesion disruption due to passage of a pressure wire

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