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@article{Rajkumar:2021:10.1161/CIRCINTERVENTIONS.120.009891,
author = {Rajkumar, C and Shun-Shin, M and Seligman, H and Ahmad, Y and Warisawa, T and Cook, C and Howard, J and Ganesananthan, S and Amarin, L and Khan, C and Ahmed, A and Nowbar, A and Foley, M and Assomull, R and Keenan, N and Sehmi, J and Keeble, T and davies, J and Tang, K and Gerber, R and Cole, G and O'Kane, P and Sharp, A and Khamis, R and Kanaganayagam, G and Petraco, R and Ruparelia, N and Malik, I and Nijjer, S and Sen, S and Francis, D and Al-Lamee, R},
doi = {10.1161/CIRCINTERVENTIONS.120.009891},
journal = {Circulation: Cardiovascular Interventions},
pages = {809--818},
title = {Placebo-controlled efficacy of percutaneous coronary intervention for focal and diffuse patterns of stable coronary artery disease},
url = {http://dx.doi.org/10.1161/CIRCINTERVENTIONS.120.009891},
volume = {14},
year = {2021}
}

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TY  - JOUR
AB  - Background Physiological assessment with pressure wire pullback can characterize coronary artery disease (CAD) with a focal or diffuse pattern. However, the clinical relevance of this distinction is unknown. We use data from ORBITA to test if the pattern of CAD predicts the placebo-controlled efficacy of percutaneous coronary intervention (PCI) on stress echocardiography ischemia and symptom endpoints.Methods164 patients in ORBITA underwent blinded instantaneous wave-free ratio (iFR) pullback assessment prior to randomization. Focal disease was defined as 0.03 iFR unit drop within 15mm, rather than over a longer distance. Analyses were performed using regression modelling. ResultsIn the PCI arm (n=85), 48 were focal and 37 were diffuse. In the placebo arm (n=79), 35 were focal and 44 were diffuse. Focal stenoses were associated with significantly lower fractional flow reserve (FFR) and iFR values than diffusely diseased vessels (focal mean FFR and iFR 0.600.15 and 0.650.24, diffuse 0.780.10 and 0.880.08 respectively, p<0.0001). With adjustment for this difference, PCI for focal stenoses resulted in significantly greater reduction in stress echo ischemia than PCI for diffuse disease (p<0.05). The effect of PCI on between-arm pre-randomization-adjusted exercise time was 9.32 seconds (95% CI, -17.1 to 35.7s; p=0.487). When stratified for pattern of disease, there was no detectable difference between focal and diffuse CAD (Pinteraction=0.700). PCI improved Seattle Angina Questionnaire angina frequency score and freedom from angina more than placebo (p=0.034; p=0.0035). However, there was no evidence of interaction between the physiological pattern of CAD and these effects (Pinteraction=0.436; Pinteraction=0.908).ConclusionPCI achieved significantly greater reduction of stress echocardiography ischemia in focal compared to diffuse CAD. However, for symptom endpoints, no such difference was observed.
AU  - Rajkumar,C
AU  - Shun-Shin,M
AU  - Seligman,H
AU  - Ahmad,Y
AU  - Warisawa,T
AU  - Cook,C
AU  - Howard,J
AU  - Ganesananthan,S
AU  - Amarin,L
AU  - Khan,C
AU  - Ahmed,A
AU  - Nowbar,A
AU  - Foley,M
AU  - Assomull,R
AU  - Keenan,N
AU  - Sehmi,J
AU  - Keeble,T
AU  - davies,J
AU  - Tang,K
AU  - Gerber,R
AU  - Cole,G
AU  - O'Kane,P
AU  - Sharp,A
AU  - Khamis,R
AU  - Kanaganayagam,G
AU  - Petraco,R
AU  - Ruparelia,N
AU  - Malik,I
AU  - Nijjer,S
AU  - Sen,S
AU  - Francis,D
AU  - Al-Lamee,R
DO  - 10.1161/CIRCINTERVENTIONS.120.009891
EP  - 818
PY  - 2021///
SN  - 1941-7640
SP  - 809
TI  - Placebo-controlled efficacy of percutaneous coronary intervention for focal and diffuse patterns of stable coronary artery disease
T2  - Circulation: Cardiovascular Interventions
UR  - http://dx.doi.org/10.1161/CIRCINTERVENTIONS.120.009891
UR  - https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.120.009891
UR  - http://hdl.handle.net/10044/1/89143
VL  - 14
ER  -

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