title: Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain?: the RIPCORD study.
abstract: BACKGROUND
  The use of coronary angiography (CA) for diagnosis and management of chest pain (CP) has several flaws. The assessment of coronary artery disease using fractional flow reserve (FFR) is a well-validated technique for describing lesion-level ischemia and improves clinical outcome in the context of percutaneous coronary intervention. The impact of routine FFR at the time of diagnostic CA on patient management has not been determined.
  
  
  RESULTS
  Two hundred patients with stable CP underwent CA for clinical indications. The supervising cardiologist (S.C.) made a management plan based on CA (optimal medical therapy alone, percutaneous coronary intervention, coronary artery bypass grafting, or more information required) and also recorded which stenoses were significant. An interventional cardiologist then measured FFR in all patent coronary arteries of stentable diameter (≥2.25 mm). S.C. was then asked to make a second management plan when FFR results were disclosed. Overall, after disclosure of FFR data, management plan based on CA alone was changed in 26% of patients, and the number and localization of functional stenoses changed in 32%. Specifically, of 72 cases in which optimal medical therapy was recommended after CA, 9 (13%) were actually referred for revascularization with FFR data. By contrast, of 89 cases in whom management plan was optimal medical therapy based on FFR, revascularization would have been recommended in 25 (28%) based on CA.
  
  
  CONCLUSIONS
  Routine measurement of FFR at CA has important influence both on which coronary arteries have significant stenoses and on patient management. These findings could have important implications for clinical practice.
  
  
  BACKGROUND
  http://www.clinicaltrial.gov. Unique identifier: NCT01070771.
authors.affiliation: From University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom (N.C., O.R., Z.N., P.G., A.C., S.C.); Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C., B.D.D.); Freeman Hospital, Newcastle upon Tyne, and Newcastle University, Tyne and Wear, United Kingdom (A.Z.); Golden Jubilee Hospital, Glasgow, United Kingdom (K.O.); Belfast City Hospital, Belfast, United Kingdom (C.H.); John Radcliffe Hospital, Oxford, United Kingdom (A.B.); Leeds General Infirmary, Leeds, United Kingdom (S.W.); Queen Alexandra Hospital, Portsmouth, United Kingdom (A.H.); Royal Derby Hospital, Derby, United Kingdom (K.C.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (D.-H.S.); and Musgrove Park Hospital, Taunton, United Kingdom (D.M.).
authors.forename: Nick
authors.initials: N
authors.lastname: Curzen
authors.forename: Omar
authors.initials: O
authors.lastname: Rana
authors.forename: Zoe
authors.initials: Z
authors.lastname: Nicholas
authors.forename: Peter
authors.initials: P
authors.lastname: Golledge
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.forename: Keith
authors.initials: K
authors.lastname: Oldroyd
authors.forename: Colm
authors.initials: C
authors.lastname: Hanratty
authors.forename: Adrian
authors.initials: A
authors.lastname: Banning
authors.forename: Stephen
authors.initials: S
authors.lastname: Wheatcroft
authors.forename: Alex
authors.initials: A
authors.lastname: Hobson
authors.forename: Kam
authors.initials: K
authors.lastname: Chitkara
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.forename: Dan
authors.initials: D
authors.lastname: McKenzie
authors.forename: Alison
authors.initials: A
authors.lastname: Calver
authors.forename: Borislav D
authors.initials: BD
authors.lastname: Dimitrov
authors.forename: Simon
authors.initials: S
authors.lastname: Corbett
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D006113:United Kingdom
keywords: angiography; coronary disease; physiology