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
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