Instantaneous wave‐free ratio for guiding treatment of nonculprit lesions in patients with acute coronary syndrome: A retrospective study

Background The aim of this study was to analyze the feasibility of a physiological coronary evaluation with the instantaneous wave‐free ratio (iFR) of nonculprit lesions in patients with acute coronary syndrome (ACS) successfully revascularized. Methods A multicenter registry including patients of f...

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Published in:Catheterization and cardiovascular interventions 2022-02, Vol.99 (2), p.489-496
Main Authors: Hidalgo, Francisco, Gonzalez‐Manzanares, Rafael, Ojeda, Soledad, Benito‐González, Tomás, Gutiérrez‐Barrios, Alejandro, De la Torre Hernández, José María, Minguito‐Carazo, Carlos, Izaga‐Torralba, Elena, Cabrera‐Rubio, Indira, Flores‐Vergara, Guisela, Lezo, Javier Suárez, Romero‐Moreno, Miguel, Prado, Armando Pérez, Pan, Manuel
Format: Article
Language:English
Subjects:
acute coronary syndrome
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - therapy
Acute coronary syndromes
Aged
Decision making
Heart attacks
Humans
Implants
instantaneous wave‐free ratio
Lesions
Middle Aged
Myocardial infarction
nonculprit lesions
Patients
Percutaneous Coronary Intervention - adverse effects
Physiology
Retrospective Studies
ST Elevation Myocardial Infarction - diagnosis
ST Elevation Myocardial Infarction - therapy
Thrombosis
Treatment Outcome
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Summary:Background The aim of this study was to analyze the feasibility of a physiological coronary evaluation with the instantaneous wave‐free ratio (iFR) of nonculprit lesions in patients with acute coronary syndrome (ACS) successfully revascularized. Methods A multicenter registry including patients of four high‐volume PCI centers with ACS and underwent successful revascularization of the culprit vessel and had other nonculprit lesions that were physiologically evaluated with the iFR between January 2017 and December 2019. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, probable or definitive stent thrombosis and new revascularization (MACEs). Results A total of 356 patients with 472 nonculprit lesions were included. The mean age was 66 ± 11 years. The clinical presentation was ACS without persistent ST‐segment elevation (NSTE‐ACS) in 235 patients (66%) and ST‐segment elevation myocardial infarction (STEMI) in 121 patients (34%). After a median follow‐up period of 21 (14‐30) months, the primary endpoint occurred in 32 patients (9%). There were no differences in outcomes regarding clinical presentation (NSTEMI vs. NSTE‐ACS, 9.1 vs. 8.9%, padj = 0.570) or iFR induced treatment strategy (patients with all lesions revascularized vs. patients with at least one lesion with an iFR > 0.89 deferred for revascularization, 10.5 vs. 8.4%, padj = 0.476). Conclusions The use of the iFR to guide percutaneous coronary intervention decision making in nonculprit lesions seems to be feasible, with an acceptable percentage of MACEs at the mid‐term follow‐up. Patients with deferred revascularization of lesions without physiological significance and patients undergoing complete revascularization had a similar risk of MACEs.
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.30025