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Physiology-guided percutaneous coronary intervention optimization technique could result in improved outcomes

Results from the randomized managed TARGET FFR trial present that whereas a physiology-guided percutaneous coronary intervention (PCI) optimization technique didn’t obtain a major enhance within the proportion of sufferers with last FFR ≥zero.90, it diminished the proportion of sufferers with a residual FFR ≤zero.80 following PCI.

Findings had been reported right now at TCT Connect, the 32nd annual scientific symposium of the Cardiovascular Research Foundation (CRF).

260 sufferers had been efficiently randomized between March 2018 and November 2019 at a single website. Following angiographically profitable PCI procedures, sufferers had been randomized (1:1) to obtain both a physiology-guided incremental optimization technique (PIOS intervention group, n=131) or blinded post-PCI coronary physiology measurements (management group, n=129). Patients present process profitable, standard-of-care PCI for both secure angina or medically stabilized non-ST-segment-elevation myocardial infarction (NSTEMI) had been eligible for randomization.

The trial’s main endpoint was outlined because the proportion of sufferers with a last post-PCI FFR end result ≥zero.90. The examine discovered that the incidence of ultimate FFR ≥zero.90 was 10% greater within the PIOS group than the management group however that the distinction was not statistically important (38.1% vs. 28.1%, p=zero.099). However, the examine’s secondary endpoint, the proportion of sufferers with last FFR ≤zero.80, was considerably decrease within the PIOS group (18.6% vs 29.eight%, p=zero.045).

Based on FFR pullback evaluation of the stented vessel, a goal for additional optimization was current in 60 of the 131 (46%) sufferers randomized to PIOS, and operators thought-about it applicable to carry out further post-dilatation +/- stenting in 40 of those 60 (66%) sufferers. Among sufferers who had additional intervention/optimization carried out, imply post-PCI FFR elevated considerably from zero.76 to zero.82 (p<.001 and="" mean="" coronary="" flow="" reserve="" increased="" from="" to="" wp_automatic_readability="15.610456553756">

“When assessing the proposed optimal post-PCI FFR cutoff value of ≥0.90, we found that the majority of patients with angiographically acceptable PCI results actually have a physiologically suboptimal outcome,” stated Damien Collison, MD, Interventional Cardiologist on the Golden Jubilee National Hospital, Glasgow, Scotland. “Up to 30% of sufferers could actually have a last FFR end result that is still beneath the guideline-directed threshold for performing revascularization within the first place. In our randomized managed trial, utility of an FFR-guided optimization technique after stenting led to enhancements in each FFR and CFR and considerably diminished the proportion of sufferers with a last post-PCI FFR ≤zero.80.


Results of a person affected person knowledge pooled evaluation reported at RCT Connect


Provided by
Cardiovascular Research Foundation

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Physiology-guided percutaneous coronary intervention optimization technique could result in improved outcomes (2020, October 17)
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