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
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
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DOI：
10.1016/j.jcin.2018.03.005
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发表时间：
2018-04-23
影响因子：
11.3
通讯作者：
Davies, Justin E.
中科院分区：
文献类型：
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作者：
Kikuta, Yuetsu;Cook, Christopher M.;Davies, Justin E.
作者试图评估瞬时无波比（iFR）回撤测量的准确性，以预测经皮冠状动脉介入治疗（PCI）后的生理结果，并量化iFR回撤在现实世界的临床环境中改变PCI策略的频率。先前已经证明，连续iFR回撤测量的离线分析能够准确预测血运重建的生理结果。然而，准确性的在线分析方法（iFR回调）仍然untested.METHODS血管造影中间串联和/或弥漫性病变进入国际，多中心iFR梯度（单瞬时无波比回调血管成形术前预测血流动力学结果没有楔压在人类冠状动脉疾病）注册。要求术者在单独进行血管造影术后提交其手术策略，然后在iFR回撤测量（结合虚拟PCI和PCI后iFR预测）后提交其手术策略。根据标准临床实践进行PCI。PCI术后，重复iFR评估，并将PCI术后iFR的实际值与预测值进行比较。在128例患者（134支血管）中测量了配对的PCI术前和术后iFR。在线计算的预测PCI后iFR为0.93+/-0.05;观察到的实际iFR为0.92+/-0.06。iFR回撤预测PCI术后iFR结局的误差为1.4+/-0.5%。与基于血管造影的决策相比，iFR回撤后，52条（31%）血管的决策发生变化;病变数量减少（-0.18+/-0.05病变/血管; p = 0.0001）和长度（-4.4+/-1.0 mm/支血管; p < 0.0001）。结论：在串联和弥漫性冠状动脉疾病中，iFR回撤预测PCI的生理结果具有高度准确性。与单纯血管造影相比，iFR回撤的可用性改变了近三分之一患者的血运重建手术计划。(c)2018作者由爱思唯尔代表美国心脏病学会基金会出版。
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. (c) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.