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Non-hyperaemic pressure ratios to guide percutaneous coronary intervention

Michail, M; Thakur, U; Mehta, O; Ramzy, JM; Comella, A; Ihdayhid, AR; Cameron, JD; ... Brown, AJ; + view all (2020) Non-hyperaemic pressure ratios to guide percutaneous coronary intervention. Open Heart , 7 (2) , Article e001308. 10.1136/openhrt-2020-001308. Green open access

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Abstract

The use of fractional flow reserve (FFR) in guiding revascularisation improves patient outcomes and has been well-established in clinical guidelines. Despite this, the uptake of FFR has been limited, likely attributable to the perceived increase in procedural time and use of hyperaemic agents that can cause patient discomfort. This has led to the development of instantaneous wave-free ratio (iFR), an alternative non-hyperaemic pressure ratio (NHPR). Since its inception, the use of iFR has been supported by an increasing body of evidence and is now guideline recommended. More recently, other commercially available NHPRs including diastolic hyperaemia-free ratio and resting full-cycle ratio have emerged. Studies have demonstrated that these indices, in addition to mean distal coronary artery pressure to mean aortic pressure ratio, are mathematically analogous (with specific nuances) to iFR. Additionally, there is increasing data demonstrating the equivalent diagnostic performance of alternative NHPRs in comparison with iFR and FFR. These NHPRs are now integral within most current pressure wire systems and are commonly available in the catheter laboratory. It is therefore key to understand the fundamental differences and evidence for NHPRs to guide appropriate clinical decision-making.

Type: Article
Title: Non-hyperaemic pressure ratios to guide percutaneous coronary intervention
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/openhrt-2020-001308
Publisher version: http://dx.doi.org/10.1136/openhrt-2020-001308
Language: English
Additional information: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Keywords: angina - unstable, coronary intervention (PCI), coronary physiology, coronary pressure, fractional flow reserve
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
URI: https://discovery.ucl.ac.uk/id/eprint/10116812
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