Routine Pressure Wire Assessment Versus Conventional Angiography in the Management of Patients With Coronary Artery Disease: The RIPCORD 2 Trial-Reference-Cited by-同舟云学术

Routine Pressure Wire Assessment Versus Conventional Angiography in the Management of Patients With Coronary Artery Disease: The RIPCORD 2 Trial

Published:2022-08-30 Issue:9 Volume:146 Page:687-698
ISSN:0009-7322
Container-title:Circulation
language:en
Short-container-title:Circulation

Author:

Stables Rodney H.¹^ORCID,Mullen Liam J.¹,Elguindy Mostafa¹^ORCID,Nicholas Zoe²,Aboul-Enien Yousra H.¹,Kemp Ian¹,O’Kane Peter³,Hobson Alex⁴,Johnson Thomas W.⁵^ORCID,Khan Sohail Q.⁶,Wheatcroft Stephen B.⁷,Garg Scot⁸^ORCID,Zaman Azfar G.⁹^ORCID,Mamas Mamas A.¹⁰^ORCID,Nolan James¹⁰,Jadhav Sachin¹¹,Berry Colin¹²^ORCID,Watkins Stuart¹³,Hildick-Smith David¹⁴,Gunn Julian¹⁵,Conway Dwayne¹⁶,Hoye Angels¹⁷,Fazal Iftikhar A.¹⁸,Hanratty Colm G.¹⁹,De Bruyne Bernard²⁰^ORCID,Curzen Nick²¹

Affiliation:

1. Liverpool Heart & Chest Hospital, UK (R.H.S., L.J.M., M.E., Y.H.A.-E., I.K.).

2. Coronary Research Group, University Hospital Southampton, UK (Z.N., N.C.).

3. Royal Bournemouth Hospital, UK (P.O.).

4. Queen Alexandra Hospital, Portsmouth, UK (A.H.).

5. Bristol Heart Institute, UK (T.W.J.).

6. Queen Elizabeth Hospital, Birmingham, UK (S.Q.K.).

7. Leeds General Infirmary, UK (S.B.W.).

8. Royal Blackburn Teaching Hospital, UK (S.G.).

9. Freeman Hospital, Newcastle, UK (A.G.Z.).

10. Royal Stoke University Hospital, Stroke-on-Trent, UK (M.A.M., J.N.).

11. City Hospital, Nottingham, UK (S.J.).

12. British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK (C.B.).

13. Golden Jubilee National Hospital, Glasgow, UK (S.W.).

14. Brighton & Sussex University Hospitals NHS Trust, Brighton, UK (D.H.-S.).

15. Northern General Hospital, Sheffield, UK (J.G.).

16. Pinderfields Hospital, Wakefield, UK (D.C.).

17. Castle Hill Hospital, Hull, UK (A.H.).

18. Kings Mill Hospital, Mansfield, UK (I.A.F.).

19. Belfast City Hospital, UK (C.G.H.).

20. Cardiovascular Research Centre, Aalst, Belgium (B.D.B.).

21. Faculty of Medicine, University of Southampton, UK (N.C.).

Abstract

Background: Measurement of fractional flow reserve (FFR) has an established role in guiding percutaneous coronary intervention. We tested the hypothesis that, at the stage of diagnostic invasive coronary angiography, systematic FFR-guided assessment of coronary artery disease would be superior, in terms of resource use and quality of life, to assessment by angiography alone. Methods: We performed an open-label, randomized, controlled trial in 17 UK centers, recruiting 1100 patients undergoing invasive coronary angiography for the investigation of stable angina or non–ST-segment–elevation myocardial infarction. Patients were randomized to either angiography alone (angiography) or angiography with systematic pressure wire assessment of all epicardial vessels >2.25 mm in diameter (angiography+FFR). The coprimary outcomes assessed at 1 year were National Health Service hospital costs and quality of life. Prespecified secondary outcomes included clinical events. Results: In the angiography+FFR arm, the median number of vessels examined was 4 (interquartile range, 3–5). The median hospital costs were similar: angiography, £4136 (interquartile range, £2613–£7015); and angiography+FFR, £4510 (£2721–£7415; P =0.137). There was no difference in median quality of life using the visual analog scale of the EuroQol EQ-5D-5L: angiography, 75 (interquartile range, 60–87); and angiography+FFR, 75 (interquartile range, 60–90; P =0.88). The number of clinical events was as follows: deaths, 5 versus 8; strokes, 3 versus 4; myocardial infarctions, 23 versus 22; and unplanned revascularizations, 26 versus 33, with a composite hierarchical event rate of 8.7% (48 of 552) for angiography versus 9.5% (52 of 548) for angiography+FFR ( P =0.64). Conclusions: A strategy of systematic FFR assessment compared with angiography alone did not result in a significant reduction in cost or improvement in quality of life. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01070771.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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