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Abstract
Introduction Pressure wire study (PWS) is a well-established tool for the assessment of the haemodynamic significance of intermediate coronary artery stenoses (40–90%). This, according to the 2018 ESC myocardial revascularization guidelines, has Class IA indication when evidence of ischaemia is not present. It can be used to calculate the fractional flow reserve (FFR), instantaneous wave-free ratio (iFR) or resting full cycle ratio (RFR) to guide revascularization decisions, with similar diagnostic accuracy between the tests. Despite the above, the utilization of PWS varies across the U.K., as reflected in the recent BCIS annual data. One possible explanation might be the fact that there are still numerous centres in the U.K, where diagnostic only coronary angiography lists take place, precluding the use of PWS at the same sitting. In our study, we aimed to review the safety of PWS as an invasive diagnostic tool and determine whether it could be incorporated in diagnostic only lists for the assessment of coronary stenoses.
Methods A retrospective assessment of all patients who underwent PWS at King’s Mill District General Hospital (Mansfield) between August 2018 - September 2020 was carried out. All patients were followed up until May 2021 (follow up period 8–33 months). Our study was registered with the local audit office. Data were obtained from our local and regional electronic records. For all patients, the following data were collected and analysed: demographics, mode of presentation, type, result and outcome related to the PWS, complications, re-attendance and outcome, as well as mortality.
Results A total of 194 patients underwent PWS during the period outlined. The majority of patients (57%) presented electively. Of those, 21 (19%) were booked as a repeat procedure, following their initial angiogram. LAD was the main vessel involved (60%). 56% of the patients had FFR and the rest either IFR or RFR. 29% of the studies were positive, resulting in revascularization. Only one minor complication was recorded (adenosine related bronchospasm) and treated successfully. Of note, 28 patients had a coronary angiogram in the 12 months preceding the index study and the index lesion had been deemed insignificant based on the angiographic appearance. 32% of these patients tested PWS positive. A total of 53 patients represented. Only 14 (7%) required revascularization of the index vessel, due to either progression of the previously PWS negative lesion or in-stent restenosis. Of the 194 patients, 6 died within the follow up period, but only 1 (0.5%) from presumed cardiac causes.
Conclusions Despite the limitations, this retrospective study reenforces the safety and usefulness of PWS in guiding revascularization decisions. It should be incorporated as a potential tool in diagnostic angiography lists. This will reduce the number of patients requiring repeat procedure, with the obvious benefits of reduced complications risk and radiation exposure. Cost effectiveness and reduction in the waiting lists are additional benefits, particularly important in the post pandemic era.
Conflict of Interest None