Does Routine Pressure Wire Assessment Influence Management Strategy at Coronary Angiography for Diagnosis of Chest Pain? The RIPCORD Study

Study Questions:

What is the impact of routine fractional flow reserve (FFR) at the time of diagnostic coronary angiography (CA) on patient management?

Methods:

Two hundred patients with stable chest pain underwent CA for clinical indications. The supervising cardiologist (S.C.) made a management plan based on CA (optimal medical therapy alone, percutaneous coronary intervention, coronary artery bypass grafting, or more information required) and also recorded which stenoses were significant. An interventional cardiologist then measured FFR in all patent coronary arteries of stentable diameter (≥2.25 mm). The S.C. was then asked to make a second management plan when FFR results were disclosed.

Results:

Overall, after disclosure of FFR data, a management plan based on CA alone was changed in 26% of patients, and the number and localization of functional stenoses changed in 32%. Specifically, of 72 cases in which optimal medical therapy was recommended after CA, 9 (13%) were actually referred for revascularization with FFR data. By contrast, of 89 cases in whom a management plan was optimal medical therapy based on FFR, revascularization would have been recommended in 25 (28%) based on CA.

Conclusions:

The authors concluded that routine measurement of FFR at CA has important influence both on which coronary arteries have significant stenoses and on patient management.

Perspective:

This study suggests that routine pressure wire assessment during diagnostic angiography in patients with stable cardiac-sounding chest pain leads to a change in management in 26% of the study population. Furthermore, it demonstrated that the number of coronary arteries considered to be significant at angiography is incorrect in 32% of cases, using the generally accepted definition of physiological significance provided by pressure wire assessment as a reference. These data may potentially have implications for routine clinical practice, and a larger randomized trial powered for resource utilization and clinical outcome including safety may help further define the role of routine FFR in this setting.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Aortic Surgery, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Coronary Stenosis, Coronary Angiography, Chest Pain, Coronary Circulation, Coronary Artery Bypass, Angioplasty, Balloon, Coronary, Percutaneous Coronary Intervention


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