Study Compares Nonhyperemic Pressure Ratios in Predicting Functional Results of PCI

December 1, 2020—Pullback-guided percutaneous coronary intervention (PCI) strategies with nonhyperemic pressure ratios (NHPRs), including instantaneous wave-free ratio (iFR), resting full-cycle ratio (RFR), and diastolic pressure ratio (dPR), reduced the number and the total length of treated lesions compared with an angiography-guided strategy. This finding comes from published results of the prospective, multicenter, randomized controlled trial, REFINE-RPG, which evaluated the accuracy of pre-PCI predicted NHPRs with actual post-PCI NHPRs and assessing the efficacy of PCI strategy using pre-PCI NHPR pullback.

Hiroyuki Omori, MD, et al published the study in the Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2020;12:2688-2698). 

The background of the study is that whereas pre-PCI longitudinal vessel interrogation with iFR, a pressure-based, adenosine-free NHPR, is feasible for predicting the functional results of PCI, the reliability of novel NHPRs (RFR and dPR) is uncertain. Researchers found that predicting functional PCI results on the basis of preprocedural RFR and dPR pullbacks yields similar results to iFR.

As summarized in JACC: Cardiovascular Interventions, 150 vessels in 140 patients were randomized 1:1:1 to receive pre-PCI iFR (n = 46), RFR (n = 49), or dPR (n = 45) pullback. The pre-PCI predicted NHPRs were compared with actual NHPRs after contemporary PCI using intravascular imaging. The number and the total length of treated lesions were compared between NHPR pullback–guided and angiography-guided strategies.

The investigators reported that the predicted NHPRs were strongly correlated with actual NHPRs: iFR, r = 0.83 (95% CI, 0.72-0.90; P < .001); RFR, r = 0.84 (95% CI, 0.73-0.91; P < .001), and dPR, r = 0.84 (95% CI, 0.73-0.91; P < .001). The number and the total length of treated lesions were lower with the NHPR pullback strategy than with the angiography-guided strategy, leading to physiologic improvement, noted the investigators in JACC: Cardiovascular Interventions. 

The study was sponsored by Gifi Heart Center in Gifu, Japan.