Author + information
- Received March 19, 2017
- Revision received March 1, 2018
- Accepted March 6, 2018
- Published online April 16, 2018.
- Yuetsu Kikuta, MDa,b,∗,
- Christopher M. Cook, MBBSa,∗,
- Andrew S.P. Sharp, MDc,
- Pablo Salinas, MDd,
- Yoshiaki Kawase, MDe,
- Yasutsugu Shiono, MD, PhDa,
- Alessandra Giavarini, MDf,
- Masafumi Nakayama, MD, PhDg,
- Salvatore De Rosa, MD, PhDh,
- Sayan Sen, MBBS, PhDa,
- Sukhjinder S. Nijjer, MBChB, PhDa,
- Rasha Al-Lamee, MDa,
- Ricardo Petraco, MD, PhDa,
- Iqbal S. Malik, MBBS, PhDa,
- Ghada W. Mikhail, MBBSa,
- Raffi R. Kaprielian, MBBS, MDa,
- Gilbert W.M. Wijntjens, MDi,
- Shinsuke Mori, MDj,
- Arata Hagikura, MDb,
- Martin Mates, MDk,
- Atsushi Mizuno, MDl,
- Farrel Hellig, MDm,
- Kelvin Lee, MDn,
- Luc Janssens, MDo,
- Kazunori Horie, MDp,
- Shah Mohdnazri, MBBSq,
- Raul Herrera, MDd,
- Florian Krackhardt, MDr,
- Masahiro Yamawaki, MDj,
- John Davies, MBBS, PhDq,
- Hideo Takebayashi, MD, PhDb,
- Thomas Keeble, MDq,
- Seiichi Haruta, MD, PhDb,
- Flavio Ribichini, MD, PhDs,
- Ciro Indolfi, MD, PhDh,
- Jamil Mayet, MBChB, MDa,
- Darrel P. Francis, MB BChir, MA, MDa,
- Jan J. Piek, MD, PhDi,
- Carlo Di Mario, MD, PhDf,
- Javier Escaned, MD, PhDd,
- Hitoshi Matsuo, MD, PhDe,∗ and
- Justin E. Davies, MBBS, PhDa,∗∗ ()
- aImperial College London and Hammersmith Hospital NHS Trust, London, United Kingdom
- bFukuyama Cardiovascular Hospital, Fukuyama, Japan
- cRoyal Devon and Exeter Hospital and University of Exeter, Exeter, United Kingdom
- dHospital Clínico San Carlos, Faculty of Medicine, Complutense University, Madrid, Spain
- eGifu Heart Center, Gifu, Japan
- fRoyal Brompton Hospital and Harefield Trust, London, United Kingdom
- gToda Central General Hospital, Toda, Japan
- hUniversita degli Studi Magna Græcia di Catanzaro, Catanzaro, Italy
- iAcademic Medical Centre, Amsterdam, the Netherlands
- jSaiseikai Yokohama City Eastern Hospital, Yokohama, Japan
- kNa Homolce Hospital, Prague, Czech Republic
- lSt Luke’s International Hospital, Tokyo, Japan
- mSunninghill Hospital, Johannesburg, University of Cape Town, South Africa
- nUnited Lincolnshire Hospital, Lincoln, United Kingdom
- oImelda Hospital, Bonheiden, Belgium
- pSendai Kousei Hospital, Sendai, Japan
- qEssex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, Essex, United Kingdom
- rCharité-Universitätsmedizin Campus Virchow, Berlin, Germany
- sUniversity of Verona, Verona, Italy
- ↵∗Address for correspondence:
Dr. Justin E. Davies, Department of Cardiology, Imperial College London, The Hammersmith Hospital, B block South, 2nd Floor, NHLI–Cardiovascular Science, Du Cane Road, London W12 0NN, United Kingdom.
Objectives The authors sought to evaluate the accuracy of instantaneous wave-Free Ratio (iFR) pullback measurements to predict post-percutaneous coronary intervention (PCI) physiological outcomes, and to quantify how often iFR pullback alters PCI strategy in real-world clinical settings.
Background In tandem and diffuse disease, offline analysis of continuous iFR pullback measurement has previously been demonstrated to accurately predict the physiological outcome of revascularization. However, the accuracy of the online analysis approach (iFR pullback) remains untested.
Methods Angiographically intermediate tandem and/or diffuse lesions were entered into the international, multicenter iFR GRADIENT (Single instantaneous wave-Free Ratio Pullback Pre-Angioplasty Predicts Hemodynamic Outcome Without Wedge Pressure in Human Coronary Artery Disease) registry. Operators were asked to submit their procedural strategy after angiography alone and then after iFR-pullback measurement incorporating virtual PCI and post-PCI iFR prediction. PCI was performed according to standard clinical practice. Following PCI, repeat iFR assessment was performed and the actual versus predicted post-PCI iFR values compared.
Results Mean age was 67 ± 12 years (81% male). Paired pre- and post-PCI iFR were measured in 128 patients (134 vessels). The predicted post-PCI iFR calculated online was 0.93 ± 0.05; observed actual iFR was 0.92 ± 0.06. iFR pullback predicted the post-PCI iFR outcome with 1.4 ± 0.5% error. In comparison to angiography-based decision making, after iFR pullback, decision making was changed in 52 (31%) of vessels; with a reduction in lesion number (−0.18 ± 0.05 lesion/vessel; p = 0.0001) and length (−4.4 ± 1.0 mm/vessel; p < 0.0001).
Conclusions In tandem and diffuse coronary disease, iFR pullback predicted the physiological outcome of PCI with a high degree of accuracy. Compared with angiography alone, availability of iFR pullback altered revascularization procedural planning in nearly one-third of patients.
↵∗ These authors are joint first authors and contributed equally to this work.
This study was funded via an unrestricted research grant from Volcano-Philips. Additional support was provided by the National Institute of Health Research Imperial Biomedical Research Center. Drs. Cook (MR/M018369/1), Nijjer (G1100443), and Sen (G1000357) are Medical Research Council fellows. Drs. Petraco (FS/11/46/28861), Davies (FS/05/006), and Francis (FS 10/038) are British Heart Foundation fellows. Drs. Kikuta, Shiono, and Petraco have been consultants for Philips/Volcano. Drs. Cook and Al-Lamee have received speaker fees from Philips/Volcano. Dr. Sharp has been a consultant for Philips/Volcano and Medtronic. Dr. Mikhail is the director of the Imperial Valve and Cardiovascular Course (IVCC), which has Philips/Volcano as one of the sponsors. Dr. Hellig has received consulting fees and honoraria from Volcano Corporation. Dr. Lee has received speaker fees from AstraZeneca, Boehringer Ingelheim, and Abbott. Drs. John Davies and Keeble have received research funding from Philips/Volcano. Dr. Indolfi has received an educational grant from Abbott Vascular. Dr. Mayet is a co-inventor of iFR technology that is under license to Philips/Volcano. Dr. Piek has been a consultant for Philips/Volcano; and has served on a medical advisory board for Abbott Vascular. Dr. Di Mario has received a research grant to his institution and speaker fees from Philips/Volcano. Dr. Escaned has been a speaker at educational events for Philips/Volcano; and a consultant for Philips/Volcano and St. Jude Medical. Dr. Justin E. Davies has been a consultant and received research funding from Philips/Volcano; and is a co-inventor of iFR technology that is under license to Philips/Volcano. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 19, 2017.
- Revision received March 1, 2018.
- Accepted March 6, 2018.
- 2018 The Authors
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.