Routine Pressure Wire Assessment Versus Conventional Angiography in the Management of Patients With Coronary Artery Disease: The RIPCORD 2 Trial

Stables, Rodney H.; Mullen, Liam J.; Elguindy, Mostafa; Nicholas, Zoe; Aboul-Enien, Yousra H.; Kemp, Ian; O’Kane, Peter; Hobson, Alex; Johnson, Thomas W.; Khan, Sohail Q.; Wheatcroft, Stephen B.; Garg, Scot; Zaman, Azfar G.; Mamas, Mamas A.; Nolan, James; Jadhav, Sachin; Berry, Colin; Watkins, Stuart; Hildick-Smith, David; Gunn, Julian; Conway, Dwayne; Hoye, Angels; Fazal, Iftikhar A.; Hanratty, Colm G.; De Bruyne, Bernard; Curzen, Nick

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.

Citation

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., …Curzen, N. (2022). Routine Pressure Wire Assessment Versus Conventional Angiography in the Management of Patients With Coronary Artery Disease: The RIPCORD 2 Trial. Circulation, 146(9), 687-698. https://doi.org/10.1161/CIRCULATIONAHA.121.057793

• Journal Article Type: Article
• Acceptance Date: Jun 13, 2022
• Online Publication Date: Aug 10, 2022
• Publication Date: Aug 30, 2022
• Journal: Circulation
• Print ISSN: 0009-7322
• Electronic ISSN: 1524-4539
• Publisher: American Heart Association
• Volume: 146
• Issue: 9
• Pages: 687-698
• DOI: https://doi.org/10.1161/CIRCULATIONAHA.121.057793
• Keywords: physiology; randomised controlled trial; coronary angiography; costs and cost analysis; quality of life
• Public URL: https://keele-repository.worktribe.com/output/423913
• Publisher URL: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057793