Comparisons of Nonhyperemic Pressure Ratios: Predicting Functional Results of Coronary Revascularization Using Longitudinal Vessel Interrogation

Hiroyuki Omori, Yoshiaki Kawase, Takuya Mizukami, Toru Tanigaki, Tetsuo Hirata, Jun Kikuchi, Hideaki Ota, Yoshihiro Sobue, Taiji Miyake, Itta Kawamura, Munenori Okubo, Hiroki Kamiya, Akihiro Hirakawa, Masanori Kawasaki, Masayasu Nakagawa, Kunihiko Tsuchiya, Yoriyasu Suzuki, Tatsuya Ito, Mitsuyasu Terashima, Takeshi KondoTakahiko Suzuki, Javier Escaned, Hitoshi Matsuo

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Objectives: The aim of this study was to investigate the accuracy of pre–percutaneous coronary intervention (PCI) predicted nonhyperemic pressure ratios (NHPRs) with actual post-PCI NHPRs and to assess the efficacy of PCI strategy using pre-PCI NHPR pullback. Background: Predicting the functional results of PCI is feasible using pre-PCI longitudinal vessel interrogation with the instantaneous wave-free ratio (iFR), a pressure-based, adenosine-free NHPR. However, the reliability of novel NHPRs (resting full-cycle ratio [RFR] and diastolic pressure ratio [dPR]) for this purpose remains uncertain. Methods: In this prospective, multicenter, randomized controlled trial, vessels were randomly assigned to receive pre-PCI iFR, RFR, or dPR pullback (50 vessels each). The pre-PCI predicted NHPRs were compared with actual NHPRs after contemporary PCI using intravascular imaging. The number and the total length of treated lesions were compared between NHPR pullback–guided and angiography-guided strategies. Results: The predicted NHPRs were strongly correlated with actual NHPRs: iFR, r = 0.83 (95% confidence interval: 0.72 to 0.90; p < 0.001); RFR, r = 0.84 (95% confidence interval: 0.73 to 0.91; p < 0.001), and dPR, r = 0.84 (95% confidence interval: 0.73 to 0.91; p < 0.001). The number and the total length of treated lesions were lower with the NHPR pullback strategy than with the angiography-guided strategy, leading to physiological improvement. Conclusions: Predicting functional PCI results on the basis of pre-procedural RFR and dPR pullbacks yields similar results to iFR. Compared with an angiography-guided strategy, a pullback–guided PCI strategy with any of the 3 NHPRs reduced the number and the total length of treated lesions. (Study to Examine Correlation Between Predictive Value and Post PCI Value of iFR, RFR and dPR; UMIN000033534)

Original languageEnglish
Pages (from-to)2688-2698
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume13
Issue number22
DOIs
Publication statusPublished - 23-11-2020
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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