Placebo-Controlled Efficacy of Percutaneous Coronary Intervention for Focal and Diffuse Patterns of Stable Coronary Artery Disease
Autor: | Andrew S.P. Sharp, Peter O'Kane, Neil Ruparelia, Sashiananthan Ganesananthan, Darrel P. Francis, Ricardo Petraco, Sukhjinder Nijjer, Christopher Rajkumar, Joban Sehmi, Ayesha Ahmed, Gajen Kanaganayagam, Kare H. Tang, Sayan Sen, Matthew J. Shun-Shin, Rasha Al-Lamee, Michael Foley, Thomas R. Keeble, Laura Amarin, Ravi Assomull, Takayuki Warisawa, Henry Seligman, Graham D. Cole, Iqbal S. Malik, Caitlin Khan, Ramzi Khamis, James P. Howard, Robert Gerber, Alexandra N. Nowbar, Niall G Keenan, Christopher Cook, John R. Davies, Yousif Ahmad |
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Přispěvatelé: | Medical Research Council (MRC), Medical Research Council |
Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Cardiac & Cardiovascular Systems APPROPRIATENESS WAVE-FREE RATIO medicine.medical_treatment Hemodynamics ischemia Coronary Artery Disease Fractional flow reserve 030204 cardiovascular system & hematology hemodynamics 1117 Public Health and Health Services Coronary artery disease 03 medical and health sciences angina pectoris Percutaneous Coronary Intervention 0302 clinical medicine Diffuse Pattern Internal medicine Angioplasty FRACTIONAL FLOW RESERVE medicine Stress Echocardiography Humans cardiovascular diseases 030212 general & internal medicine Coronary Artery Bypass ANGIOPLASTY 1102 Cardiorespiratory Medicine and Haematology Science & Technology business.industry Percutaneous coronary intervention PCI 1103 Clinical Sciences Original Articles medicine.disease Coronary Physiologic Assessment and Imaging Cardiovascular System & Hematology Conventional PCI Cardiovascular System & Cardiology ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Cardiology Cardiology and Cardiovascular Medicine business Life Sciences & Biomedicine |
Zdroj: | Circulation. Cardiovascular Interventions |
ISSN: | 1941-7632 1941-7640 0206-2593 |
DOI: | 10.1161/circinterventions.120.009891 |
Popis: | Supplemental Digital Content is available in the text. Background: Physiological assessment with pressure wire pullback can characterize coronary artery disease (CAD) with a focal or diffuse pattern. However, the clinical relevance of this distinction is unknown. We use data from the ORBITA trial (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) to test if the pattern of CAD predicts the placebo-controlled efficacy of percutaneous coronary intervention (PCI) on stress echocardiography ischemia and symptom end points. Methods: One hundred sixty-four patients in ORBITA underwent blinded instantaneous wave-free ratio (iFR) pullback assessment before randomization. Focal disease was defined as a ≥0.03 iFR unit drop within 15 mm, rather than over a longer distance. Analyses were performed using regression modeling. Results: In the PCI arm (n=85), 48 were focal and 37 were diffuse. In the placebo arm (n=79), 35 were focal and 44 were diffuse. Focal stenoses were associated with significantly lower fractional flow reserve (FFR) and iFR values than diffusely diseased vessels (mean FFR and iFR, focal 0.60±0.15 and 0.65±0.24, diffuse 0.78±0.10 and 0.88±0.08, respectively, P |
Databáze: | OpenAIRE |
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