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iFR uncovers profound but mostly reversible ischemia in CTOs and helps to optimize PCI results
Author(s) -
Kayaert Peter,
Coeman Mathieu,
Drieghe Benny,
Bennett Johan,
McCutcheon Keir,
Dens Jo,
Ungureanu Claudiu,
Zivelonghi Carlo,
Agostoni Pierfrancesco,
Bataille Yoann,
Hemptinne Quentin,
Gevaert Sofie,
Pauw Michel,
Haine Steven
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29072
Subject(s) - conventional pci , medicine , fractional flow reserve , cardiology , ischemia , revascularization , pullback , myocardial infarction , coronary angiography , geometry , mathematics
Objectives The study aimed to demonstrate through instant wave‐free ratio (iFR) measurements that myocardium distal to a chronic total occlusion (CTO) is ischemic, that ischemia is reversible by PCI, and that iFR assessment after PCI can be used to optimize PCI results. Background The greatest benefit of revascularization is found in patients with low fractional flow reserve. In patients with CTOs, iFR measurement may be more appropriate to evaluate ischemia as it does not require maximal microvascular vasodilation, which may be hampered by microvascular dysfunction. Methods The iFR was measured in 81 CTO patients, both pre‐ and post‐PCI in 63 patients, and only post‐PCI in the following 18 patients. A pressure wire pullback was performed post‐PCI if iFR ≤0.89. Results The first 63 patients all had significant ischemia distal to the CTO with a median iFR of 0.33 [0.22; 0.44], improving significantly post‐PCI to a median iFR of 0.93 [0.89;0.96] ( p < .001). In the complete cohort, the median iFR post‐PCI was 0.93 [0.86;0.96] but still ≤0.89 in 23 patients (30%). 12 of these patients had further PCI optimization because of a residual focal pressure gradient on pullback, after which only two had a final iFR ≤0.89. Conclusions In CTO patients with an indication for PCI, iFR consistently demonstrated profound myocardial ischemia. Successful PCI immediately relieved ischemia in 70% of patients. In the remaining 30% of cases, a manual iFR pullback proved helpful in guiding further optimization of the PCI result.