| Title: |
Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Single-Vessel Coronary Artery Disease: Physiology-Stratified Analysis of ORBITA |
| Authors: |
Al-Lamee, R; Howard, JP; Shun-Shin, MJ; Thompson, D; Dehbi, H-M; Sen, S; Nijjer, S; Petraco, R; Davies, J; Keeble, T; Tang, K; Malik, IS; Cook, C; Ahmad, Y; Sharp, ASP; Gerber, R; Baker, C; Kaprielian, R; Talwar, S; Assomull, R; Cole, G; Keenan, NG; Kanaganayagam, G; Sehmi, J; Wensel, R; Harrell, FE; Mayet, J; Thom, SA; Davies, JE; Francis, DP |
| Source: |
Circulation , 137 (23) , Article 118.033801. (2018) |
| Publication Year: |
2018 |
| Collection: |
University College London: UCL Discovery |
| Subject Terms: |
angina; stable; clinical trial; fractional flow reserve; myocardial; ischemia; percutaneous coronary intervention |
| Description: |
BACKGROUND : There are no data on how fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are associated with the placebo-controlled efficacy of percutaneous coronary intervention (PCI) in stable single-vessel coronary artery disease. METHODS : We report the association between prerandomization invasive physiology within ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina), a placebo-controlled trial of patients who have stable angina with angiographically severe single-vessel coronary disease clinically eligible for PCI. Patients underwent prerandomization research FFR and iFR assessment. The operator was blinded to these values. Assessment of response variables, treadmill exercise time, stress echocardiography score, symptom frequency, and angina severity were performed at prerandomization and blinded follow-up. Effects were calculated by analysis of covariance. The ability of FFR and iFR to predict placebo-controlled changes in response variables was tested by using regression modeling. RESULTS : Invasive physiology data were available in 196 patients (103 PCI and 93 placebo). At prerandomization, the majority had Canadian Cardiovascular Society class II or III symptoms (150/196, 76.5%). Mean FFR and iFR were 0.69±0.16 and 0.76±0.22, respectively; 97% had ≥1 positive ischemia tests. The estimated effect of PCI on between-arm prerandomization-adjusted total exercise time was 20.7 s (95% confidence interval [CI], -4.0 to 45.5; P=0.100) with no interaction of FFR (Pinteraction=0.318) or iFR (Pinteraction=0.523). PCI improved stress echocardiography score more than placebo (1.07 segment units; 95% CI, 0.70-1.44; P |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| Relation: |
https://discovery.ucl.ac.uk/id/eprint/10049825/ |
| Availability: |
https://discovery.ucl.ac.uk/id/eprint/10049825/1/Al-Lamee_ORBITA-PHYSIOLOGY_revised_080418_notracked%20changes.pdf; https://discovery.ucl.ac.uk/id/eprint/10049825/ |
| Rights: |
open |
| Accession Number: |
edsbas.9A1A9954 |
| Database: |
BASE |