Changes in the Treatment Strategy Following Intracoronary Pressure Wire in a Contemporaneous Real-Life Cohort of Patients With Intermediate Coronary Stenosis. Results From a Nationwide Registry

• Published in: Cardiovascular revascularization medicine Vol. 51; pp. 55 - 64
• Main Authors: Rodriguez-Leor, Oriol, Toledano, Beatriz, López-Palop, Ramón, Rivero, Fernando, Brugaletta, Salvatore, Linares, José Antonio, Benito, Tomás, Carrillo, Pilar, Puigfel, Martí, Cediel, German, Sadaba, Mario, Vaquerizo, Beatriz, Rondán, Juan, Gómez, Iván, Alfonso, Fernando, Sáez, Roberto, Planas, Ana, Lozano, Fernando, Hernández, Felipe, Sabaté, Manel, Ruíz-Arroyo, José Ramón, Torres, Francisco, de la Torre Hernández, José María, Gutiérrez, Enrique, Cid-Álvarez, Ana Belén, Díez, José Luís, Fernández, Luis, Moreu, José, Ojeda, Soledad, Cerrato, Pablo, Ruiz-Quevedo, Valeriano, Sanchis, Juan, Gómez-Menchero, Antonio, Ocaranza, Raymundo, Mohandes, Mohsen, Hernández, José María, Alfageme, Miren Maite, Aguiar, Pablo, López Mínguez, José Ramón, Pérez de Prado, Armando
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2023
• Subjects: Coronary Angiography; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - therapy; FFR; Humans; Non-hyperemic diastolic indices; Percutaneous Coronary Intervention - adverse effects; Pressure wire; Prospective Studies; Registries; Registry; Treatment Outcome; ICPW; FFR; iFR; MACE; CAD; PCI; Pressure wire; NHPR; Registry; CABG; Coronary artery disease; Non-hyperemic diastolic indices
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2023.01.027

Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease. To evaluate changes in diagnosis (coronary artery disease extent), treatment strategy and clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis. Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed. 1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0 %). The extent of coronary artery disease changed in 771 patients (54.5 %). There was a change in treatment strategy in 779 patients (55.1 %) (18.0 % if medical treatment; 68.8 % if PCI; 58.9 % if surgery (p < 0.001 for PCI vs medical treatment; p = 0.041 for PCI vs CABG; p < 0.001 for medical treatment vs CABG)). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6 % vs 8.2 %, p = 0.034). The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment. •In a non-controlled, real-life setting, the pressure wire is safe, with an extremely low complications rate.•Following pressure wire use, we have demonstrated a very significant change in assessment of the extent of coronary disease.•Following pressure wire use, we have evidenced a very significant change not only in treatment modality (medical, PCI or CABG) but also in management strategy.•We have shown that the change in treatment modality and/or strategy has prognostic implications, particularly in those patients in which the initial intention was to perform PCI.•These results are different from those observed in previous studies conducted in populations with very limited representation of patients with ACS and in reimbursement-based healthcare systems.