Comparisons of Nonhyperemic Pressure Ratios

• Published in: JACC. Cardiovascular interventions Vol. 13; no. 22; pp. 2688 - 2698
• Main Authors: Omori, Hiroyuki, Kawase, Yoshiaki, Mizukami, Takuya, Tanigaki, Toru, Hirata, Tetsuo, Kikuchi, Jun, Ota, Hideaki, Sobue, Yoshihiro, Miyake, Taiji, Kawamura, Itta, Okubo, Munenori, Kamiya, Hiroki, Hirakawa, Akihiro, Kawasaki, Masanori, Nakagawa, Masayasu, Tsuchiya, Kunihiko, Suzuki, Yoriyasu, Ito, Tatsuya, Terashima, Mitsuyasu, Kondo, Takeshi, Suzuki, Takahiko, Escaned, Javier, Matsuo, Hitoshi
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 23.11.2020
• Subjects: intravascular imaging; nonhyperemic pressure ratio; percutaneous coronary intervention; pullback; CSA; percutaneous coronary intervention; FFR; nonhyperemic pressure ratio; pullback; iFR; CI; dPR; PCI; NHPR; intravascular imaging; RFR
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2020.06.060

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. 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. 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. 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. 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) [Display omitted]