Improvement in coronary haemodynamics after percutaneous coronary intervention: Assessment using instantaneous wave-free ratio

Nijjer, S; Sen, S; Petraco, R; Sachdeva, R; Cuculi, F; Escaned, J; Broyd, C; Foin, N; Hadjiloizou, N; Foale, R; Malik, I; Mikhail, G; Sethi, A; Al-Bustami, M; Kaprielian, R; Khan, M; Baker, C; Bellamy, M; Hughes, A; Mayet, J; Kharbanda, R; Di Mario, C; Davies, J

Journal article

Improvement in coronary haemodynamics after percutaneous coronary intervention: Assessment using instantaneous wave-free ratio

Abstract:: Objective: To determine whether the instantaneous wave-free ratio (iFR) can detect improvement in stenosis significance after percutaneous coronary intervention (PCI) and compare this with fractional flow reserve (FFR) and whole cycle Pd/Pa. Design: A prospective observational study was undertaken in elective patients scheduled for PCI with FFR ≤0.80. Intracoronary pressures were measured at rest and during adenosine-mediated vasodilatation, before and after PCI. iFR, Pd/Pa and FFR values were calculated using the validated fully automated algorithms. Setting: Coronary catheter laboratories in two UK centres and one in the USA. Patients: 120 coronary stenoses in 112 patients were assessed. The mean age was 63±10 years, while 84% were male; 39% smokers; 33% with diabetes. Mean diameter stenosis was 68±16% by quantitative coronary angiography. Results: Pre-PCI, mean FFR was 0.66±0.14, mean iFR was 0.75±0.21 and mean Pd/Pa 0.83±0.16. PCI increased all indices significantly (FFR 0.89±0.07, p<0.001; iFR 0.94±0.05, p<0.001; Pd/Pa 0.96±0.04, p<0.001). The change in iFR after intervention (0.20 ±0.21) was similar to ÄFFR 0.22±0.15 (p=0.25). ΔFFR and ΔiFR were significantly larger than resting ΔPd/Pa (0.13±0.16, both p<0.001). Similar incremental changes occurred in patients with a higher prevalence of risk factors for microcirculatory disease such as diabetes and hypertension. Conclusions: iFR and FFR detect the changes in coronary haemodynamics elicited by PCI. FFR and iFR have a signi ficantly larger dynamic range than resting Pd/Pa. iFR might be used to objectively document improvement in coronary haemodynamics following PCI in a similar manner to FFR.

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APA Style

Nijjer, S., Sen, S., Petraco, R., Sachdeva, R., Cuculi, F., Escaned, J., Broyd, C., Foin, N., Hadjiloizou, N., Foale, R., Malik, I., Mikhail, G., Sethi, A., Al-Bustami, M., Kaprielian, R., Khan, M., Baker, C., Bellamy, M., Hughes, A., … Davies, J. (2013). Improvement in coronary haemodynamics after percutaneous coronary intervention: Assessment using instantaneous wave-free ratio. Heart, 99(23), 1740–1748.

MLA Style

Nijjer, S., et al. “Improvement in Coronary Haemodynamics after Percutaneous Coronary Intervention: Assessment Using Instantaneous Wave-Free Ratio.” Heart, vol. 99, no. 23, 2013, pp. 1740–48.

Chicago Style

Nijjer, S, S Sen, R Petraco, R Sachdeva, F Cuculi, J Escaned, C Broyd, et al. 2013. “Improvement in Coronary Haemodynamics after Percutaneous Coronary Intervention: Assessment Using Instantaneous Wave-Free Ratio.” Heart 99 (23): 1740–48.
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