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Impact of the iFR co-registration pullback system on revascularization
Session:
Painel 11 - Cardiologia Intervenção 4
Speaker:
Rafael Santos
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.1 Invasive Imaging and Functional Assessment
Session Type:
Posters
FP Number:
---
Authors:
Rafael Santos; Miguel Nobre Menezes; P. Carrilho Ferreira; Claudia Jorge; João Marques; J. Almeida Duarte; José Marques da Costa; Joana Rigueira; Afonso Nunes Ferreira; Tiago Graça Rodrigues; Sara Couto Pereira; Joana Brito; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p><strong>Introduction:</strong> since the publication of the DEFINE-FLAIR and the IFR-SWEDHEART trials, the use of iFR has grown. In addition to that, a co-registration system which displays the angiogram and the iFR values while doing a wire pullback has been developed. It has been hypothesized that this system enables precise identification of the lesion(s) which contribute the most to the ischemia burden, potentially reducing the number and/or length of stents used during PCI by avoiding deployment in less relevant segments.</p> <p><strong>Purpose:</strong> to assess the impact in revascularization decisions of the IFR pullback and co-registration systems</p> <p><strong>Methods:</strong> prospective single center study of patients submitted to functional lesion assessment with IFR since May 2017 until November 2019. The threshold for revascularization was an IFR ≤ 0,89. Demographic, clinical and procedural characteristics were collected. Cases were divided in two groups: those where pullback and co-registration was undertaken (co-registration group) and those where it was not (reference group). The decision to revascularize, mean iFR value, total number of stents and total stent length was compared between the 2 groups. For statistical analysis of association, we used T-tests (quantitative variables) and chi-square test (qualitative variables).</p> <p><strong>Results:</strong> IFR assessment was performed in 387 lesions (332 patients, mean age 67±11 years, 70% men). Pullback and co-registration were performed in 133 lesions (30,8%).</p> <p>The iFR mean value was 0,86±0,12 in the co-registration group, significantly lower when compared with the reference group - 0,90±0,11(p= 0,002). This resulted in statistically significant (p = 0,009) greater number of revascularization in the former group – 40,6% (35,3% with PCI and 5,3% with CABG) vs 27,6% (24,4% with PCI and 3,1% with CABG).</p> <p>In patients undergoing PCI, there was a relatively higher number of stents (1,35 vs 1,22) and total stent length (32,42mm vs 27,80mm) implanted in the co-registration group vs the reference group. Still, these differences had no statistical significance (number of stents p= 0,214 and stent length p= 0,166).</p> <p><strong>Conclusion:</strong> In our center, performing IFR pullback with co-registration resulted in a higher revascularization rate than simple iFR appreciation alone. However, in patients undergoing PCI, there was no difference in stent number or total length between groups. This may be the result of a mixed effect in the co-registration group: the system identifies very focal ischemia in some cases (leading to fewer/shorter stents), but also diffuse ischemia even when not clearly apparent on the angiogram (leading to more/longer stents) therefore balancing the overall effect on stent number and length.</p> <p> </p>
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