Stables, R. H. et al. (2022) Routine pressure wire assessment versus conventional angiography in the management of patients with coronary artery disease: the RIPCORD 2 trial. Circulation, 146(9), pp. 687-698. (doi: 10.1161/CIRCULATIONAHA.121.057793) (PMID:35946404)
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Abstract
Background: Measurement of fractional flow reserve (FFR) has an established role in guiding percutaneous coronary intervention. We tested the hypothesis that, at the stage of diagnostic invasive coronary angiography, systematic FFR-guided assessment of coronary artery disease would be superior, in terms of resource use and quality of life, to assessment by angiography alone. Methods: We performed an open-label, randomized, controlled trial in 17 UK centers, recruiting 1100 patients undergoing invasive coronary angiography for the investigation of stable angina or non–ST-segment–elevation myocardial infarction. Patients were randomized to either angiography alone (angiography) or angiography with systematic pressure wire assessment of all epicardial vessels >2.25 mm in diameter (angiography+FFR). The coprimary outcomes assessed at 1 year were National Health Service hospital costs and quality of life. Prespecified secondary outcomes included clinical events. Results: In the angiography+FFR arm, the median number of vessels examined was 4 (interquartile range, 3–5). The median hospital costs were similar: angiography, £4136 (interquartile range, £2613–£7015); and angiography+FFR, £4510 (£2721–£7415; P=0.137). There was no difference in median quality of life using the visual analog scale of the EuroQol EQ-5D-5L: angiography, 75 (interquartile range, 60–87); and angiography+FFR, 75 (interquartile range, 60–90; P=0.88). The number of clinical events was as follows: deaths, 5 versus 8; strokes, 3 versus 4; myocardial infarctions, 23 versus 22; and unplanned revascularizations, 26 versus 33, with a composite hierarchical event rate of 8.7% (48 of 552) for angiography versus 9.5% (52 of 548) for angiography+FFR (P=0.64). Conclusions: A strategy of systematic FFR assessment compared with angiography alone did not result in a significant reduction in cost or improvement in quality of life. Registration: URL: https://www.clinicaltrials.gov; Unique identifier NCT01070771.
| Item Type: | Articles |
|---|---|
| Keywords: | Coronary angiography, quality of life, physiology, costs and cost analysis, randomized controlled trial. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Berry, Professor Colin and Watkins, Dr Stuart |
| Authors: | Stables, R. H., Mullen, L. J., Elguindy, M., Nicholas, Z., Aboul-Enien, Y. H., Kemp, I., O'Kane, P., Hobson, A., Johnson, T. W., Khan, S. Q., Wheatcroft, S. B., Garg, S., Zaman, A. G., Mamas, M. A., Nolan, J., Jadhav, S., Berry, C., Watkins, S., Hildick-Smith, D., Gunn, J., Conway, D., Hoye, A., Fazal, I. A., Hanratty, C. G., De Bruyne, B., and Curzen, N. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | Circulation |
| Publisher: | American Heart Association |
| ISSN: | 0009-7322 |
| ISSN (Online): | 1524-4539 |
| Published Online: | 10 August 2022 |
| Copyright Holders: | Copyright © 2022 American Heart Association, Inc. |
| First Published: | First published in Circulation 146(9): 687-698 |
| Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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