Impact of Routine Invasive Physiology at Time of Angiography in Patients With Multivessel Coronary Artery Disease on Reclassification of Revascularization Strategy: Results From the DEFINE REAL Study

JACC. Cardiovascular Interventions
Eric Van BelleGennaro Sardella

Abstract

This study sought to prospectively assess the impact of routine invasive physiology at the time of angiography on reclassification of therapeutic management of multivessel disease (MVD) patients, and to assess how implementation of instantaneous wave-free ratio (iFR) alters the process. Routine invasive physiology in intermediate coronary lesions at the time of diagnostic angiography, primarily in patients with single-vessel disease and using fractional flow reserve (FFR), reclassifies coronary revascularization management in 26% to 44% of patients. The role of invasive physiology in patients with MVD is unclear. In 18 centers, 484 patients undergoing diagnostic angiography disclosing MVD with lesions >40% by visual assessment were included. Investigators were asked to prospectively define their initial management strategy based on angiography and clinical information. Invasive physiology (FFR or iFR driven) was then performed and final strategy defined. Initial and final vessel, patient, procedural, and overall management were described. Reclassification was defined as the difference between initial and final strategy. The majority of patients were clinically stable (82.2%). Two- and 3-vessel disease was present in 73.3% and 2...Continue Reading

Citations

Aug 12, 2020·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·T P van de HoefJ J Piek
Sep 25, 2019·Clinical Physiology and Functional Imaging·Rafik B ShenoudaMichael Y Henein
Apr 25, 2020·JACC. Cardiovascular Interventions·Eric Van BelleSergio Bravo Baptista
Jan 18, 2021·JACC. Cardiovascular Imaging·Eric Van BelleJonathon Leipsic
Mar 30, 2021·Frontiers in Cardiovascular Medicine·Jean-François ArgachaBernard Cosyns
Jul 7, 2020·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Eric Van BelleDariusz Dudek

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