Clinical use of physiological lesion assessment using pressure guidewires: an expert consensus document of the Japanese association of cardiovascular intervention and therapeutics—update 2022

Kawase, Yoshiaki; Matsuo, Hitoshi; Kuramitsu, Shoichi; Shiono, Yasutsugu; Tanaka, Nobuhiro; Amano, Tetsuya; Kozuma, Ken; Nakamura, Masato; Yokoi, Hiroyoshi; Kobayashi, Yoshio; Ikari, Yuji

doi:10.1007/s12928-022-00863-1

Cited by 30 publications

(15 citation statements)

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“…When further downstream disease was present in the LAD or left circumflex artery, the wire was placed either in the nondiseased artery or proximal to the first angiographical stenosis. In actual measurement of iFR, disengagement of the guiding catheter from the left coronary artery orifice was appropriately confirmed as recommended, 12 considering that some cases have ostial disease of LM stem.…”

Section: Methodsmentioning

confidence: 99%

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Deferred Versus Performed Revascularization for Left Main Coronary Disease With Hemodynamic Significance

Warisawa

Cook

Ahmad

et al. 2023

Circ: Cardiovascular Interventions

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Background: The majority of randomized controlled trials of revascularization decision-making excludes left main coronary artery disease (LMD). Therefore, contemporary clinical outcomes of patients with stable coronary artery disease and LMD with proven ischemia remain poorly understood. The aim of this study was to assess the long-term clinical outcomes of physiologically significant LMD according to the treatment strategies of revascularization versus revascularization deferral. Methods: In this international multicenter registry of stable LMD interrogated with the instantaneous wave-free ratio, patients with physiologically significant ischemia (instantaneous wave-free ratio ≤0.89) were analyzed according to the coronary revascularization (n=151) versus revascularization deferral (n=74). Propensity score matching was performed to adjust for baseline clinical characteristics. The primary end point was a composite of death, nonfatal myocardial infarction, and ischemia-driven target lesion revascularization of left main stem. The secondary end points were as follows: cardiac death or spontaneous LMD-related myocardial infarction; and ischemia-driven target lesion revascularization of left main stem. Results: At a median follow-up period of 2.8 years, the primary end point occurred in 11 patients (14.9%) in the revascularized group and 21 patients (28.4%) in the deferred group (hazard ratio, 0.42 [95% CI, 0.20–0.89]; P =0.023). For the secondary end points, cardiac death or LMD-related myocardial infarction occurred significantly less frequently in the revascularized group (0.0% versus 8.1%; P =0.004). The rate of ischemia-driven target lesion revascularization of left main stem was also significantly lower in the revascularized group (5.4% versus 17.6%; hazard ratio, 0.20 [95% CI, 0.056–0.70]; P =0.012). Conclusions: In patients who underwent revascularization for stable coronary artery disease and physiologically significant LMD determined by instantaneous wave-free ratio, the long-term clinical outcomes were significantly improved as compared with those in whom revascularization was deferred.

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Section: Methodsmentioning

confidence: 99%

“…In actual measurement of iFR, disengagement of the guiding catheter from the left coronary artery orifice was appropriately confirmed as recommended, 12 considering that some cases have ostial disease of LM stem.…”

Section: Study Populationmentioning

confidence: 99%

Deferred Versus Performed Revascularization for Left Main Coronary Disease With Hemodynamic Significance

Warisawa

Cook

Ahmad

et al. 2023

Circ: Cardiovascular Interventions

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“…The 2017 ESC guidelines allowed non-invasive stress tests during hospital stay after primary PCI to evaluate myocardial ischemia and viability (Class IIb, level of evidence C) in patients with STEMI [ 32 ]. A consensus document by the Japanese Association of Cardiovascular Intervention and Therapeutics suggests the use of physiological evaluation following acute MI, such as FFR, NHPR, and quantitative flow ratio before staged PCI in non-culprit vessels [ 33 ]. Given that instantaneous wave-free ratio (iFR), one of NHPRs, was shown not to be altered in a setting of STEMI and in the follow-up evaluation [ 26 , 34 ], acute NHPR assessment during the index procedure for MI might be considered.…”

Section: Introductionmentioning

confidence: 99%

Complete revascularization in acute myocardial infarction: a clinical review

Saito

Kobayashi

2023

Cardiovasc Interv and Ther

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In patients with ST segment elevation and non-ST elevation myocardial infarction (MI), multivessel (MV) coronary artery disease is found in approximately 50%, leading to worse clinical outcomes. Recent data have suggested that complete revascularization with MV percutaneous coronary intervention is associated with a reduced risk of major adverse cardiovascular events as compared to culprit vessel-only revascularization. However, the optimal timing of MV intervention, appropriate non-culprit lesion assessment, and the best revascularization strategy in specific subsets such as cardiogenic shock remain to be established. This review article summarizes current evidence on revascularization strategies in patients with acute MI and MV disease.

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“…Physiological assessment was then performed according to standard technique. [ 13 , 14 ] A pressure guidewire with optical fibers (OptWire® II or III, Zeon Medical Inc., Tokyo, Japan) was used for intracoronary pressure measurements. The guidewire was calibrated outside the body and advanced to the catheter tip.…”

Section: Methodsmentioning

confidence: 99%

Comparative study of fractional flow reserve and diastolic pressure ratio using a guidewire with a sensor for measuring intravascular pressure

et al. 2022

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Purpose: This study aimed to evaluate the correlation and diagnostic agreement between diastolic pressure ratio (dPR) and fractional flow reserve (FFR) in a Japanese real-world setting. Design: Prospective multicenter observational study Methods: This study included 100 patients with intermediate coronary artery stenosis at 4 Japanese hospitals. For these lesions, FFR and dPR were measured using a guidewire with a sensor and a monitor to measure intravascular pressure. The correlation and diagnostic agreement between FFR and dPR were assessed. When both FFR and dPR were negative or positive, the results were considered to be concordant. When one was positive and the other was negative, the result was regarded as discordant (positive discordance, FFR > 0.80 and dPR ≤ 0.89; negative discordance, FFR ≤ 0.80 and dPR > 0.89). Results: Overall, the FFR and dPR were well-correlated ( R = 0.841). FFR and dPR were concordant in 89% of cases (concordant normal, 43%; concordant abnormal, 46%) and discordant in 11% (positive discordance, 7%; negative discordance, 4%). No significant difference was observed in the rate of concordant results between patients with and without diabetes mellitus. The diagnostic concordance rate was significantly different among the 3 coronary arteries (right coronary artery, 93.3%; left anterior descending artery, 93.2%; and left circumflex artery, 58.3%; P = .001). Additionally, the rate of concordant results tended to be higher when using intravenous administration of adenosine than when using intracoronary bolus injection of nicorandil (adenosine, 95.1%; nicorandil, 84.7%; P = .103). Conclusion: We found that dPR was highly correlated with FFR, and diagnostic discordance was observed in 11% of the lesions. Several factors, including lesion location and medication for hyperemia, may cause the diagnostic discordance between dPR and FFR.

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Clinical use of physiological lesion assessment using pressure guidewires: an expert consensus document of the Japanese association of cardiovascular intervention and therapeutics—update 2022

Cited by 30 publications

References 100 publications

Deferred Versus Performed Revascularization for Left Main Coronary Disease With Hemodynamic Significance

Deferred Versus Performed Revascularization for Left Main Coronary Disease With Hemodynamic Significance

Complete revascularization in acute myocardial infarction: a clinical review

Comparative study of fractional flow reserve and diastolic pressure ratio using a guidewire with a sensor for measuring intravascular pressure

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