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Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain? The RIPCORD Study

Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain? The RIPCORD Study
Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain? The RIPCORD Study
Background — The use of coronary angiography (CA) for diagnosis and management of chest pain (CP) has several flaws. The assessment of coronary artery disease using fractional flow reserve (FFR) is a well-validated technique for describing lesion-level ischemia and improves clinical outcome in the context of percutaneous coronary intervention. The impact of routine FFR at the time of diagnostic CA on patient management has not been determined.

Method and Results — Two hundred patients with stable CP 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). S.C. was then asked to make a second management plan when FFR results were disclosed. Overall, after disclosure of FFR data, 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 management plan was optimal medical therapy based on FFR, revascularization would have been recommended in 25 (28%) based on CA.

Conclusions — Routine measurement of FFR at CA has important influence both on which coronary arteries have significant stenoses and on patient management. These findings could have important implications for clinical practice.
1941-7640
248-255
Curzen, Nick
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Rana, Omar
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Nicholas, Zoe
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Golledge, Peter
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Zaman, Azfar
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Oldroyd, Keith
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Hanratty, Colm
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Banning, Adrian
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Wheatcroft, Stephen
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Hobson, Alex
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Chitkara, Kam
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Hildick-Smith, David
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McKenzie, Dan
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Calver, Alison
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Dimitrov, Borislav D.
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Corbett, Simon
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Curzen, Nick
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Rana, Omar
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Nicholas, Zoe
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Golledge, Peter
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Zaman, Azfar
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Oldroyd, Keith
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Hanratty, Colm
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Banning, Adrian
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Wheatcroft, Stephen
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Hobson, Alex
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Chitkara, Kam
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Hildick-Smith, David
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McKenzie, Dan
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Calver, Alison
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Dimitrov, Borislav D.
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Corbett, Simon
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Curzen, Nick, Rana, Omar, Nicholas, Zoe, Golledge, Peter, Zaman, Azfar, Oldroyd, Keith, Hanratty, Colm, Banning, Adrian, Wheatcroft, Stephen, Hobson, Alex, Chitkara, Kam, Hildick-Smith, David, McKenzie, Dan, Calver, Alison, Dimitrov, Borislav D. and Corbett, Simon (2014) Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain? The RIPCORD Study. Circulation Cardiovascular Interventions, 248-255. (doi:10.1161/CIRCINTERVENTIONS.113.000978). (PMID:24642999)

Record type: Article

Abstract

Background — The use of coronary angiography (CA) for diagnosis and management of chest pain (CP) has several flaws. The assessment of coronary artery disease using fractional flow reserve (FFR) is a well-validated technique for describing lesion-level ischemia and improves clinical outcome in the context of percutaneous coronary intervention. The impact of routine FFR at the time of diagnostic CA on patient management has not been determined.

Method and Results — Two hundred patients with stable CP 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). S.C. was then asked to make a second management plan when FFR results were disclosed. Overall, after disclosure of FFR data, 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 management plan was optimal medical therapy based on FFR, revascularization would have been recommended in 25 (28%) based on CA.

Conclusions — Routine measurement of FFR at CA has important influence both on which coronary arteries have significant stenoses and on patient management. These findings could have important implications for clinical practice.

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e-pub ahead of print date: 18 March 2014
Published date: 2014
Organisations: Primary Care & Population Sciences

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Local EPrints ID: 363427
URI: https://eprints.soton.ac.uk/id/eprint/363427
ISSN: 1941-7640
PURE UUID: a2087cfa-0a9f-416c-bc13-ab432a390d9b

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Date deposited: 24 Mar 2014 16:36
Last modified: 09 Sep 2019 18:44

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