Use of Intracoronary Pressure Wire Assessment and Association With Outcomes: Insights From the British Cardiovascular Intervention Society National Database

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BACKGROUND: Despite recommendations in international guidelines, Intracoronary pressure wire assessment (PWA) utilization remains limited in clinical practice. This study aims to describe (i) trends of PWA during Percutaneous coronary interventional (PCI), (ii) factors that predict its application, and (iii) association with in-hospital outcomes. METHODS: Adults with PCI for chronic coronary syndrome or Non-ST-elevation acute coronary syndrome in the British Cardiovascular Intervention Society (BCIS) database from January 2012 to March 2020 were included. Adjusted odds ratios (aOR) of PWA predictors and its association with in-hospital major adverse cardiovascular and cerebrovascular events (MACCE; a composite of total mortality, stroke/transient ischaemic attack, and new/reinfarction) were assessed using logistic regression models. RESULTS: 303,453 records identified of which 10.74% had PWA. There was a modest rise in the use of PWA from 9.1% in 2012 to peak just over 13% in 2018. Intracoronary imaging (aOR: 1.23, 95% CI: 1.18-1.27, p < 0.001), and previous PCI (aOR: 1.30, 95% CI: 1.26-1.34, p < 0.001) were positive predictors of PWA. MACCE was lower with PWA (aOR: 0.73, 95% CI: 0.62-0.87, p < 0.001) in the overall population. PWA was associated with lower procedural complications (aOR: 0.90, 95% CI: 0.84-0.96, P: 0.001). CONCLUSION: PWA remains underutilized in UK real world practice. Among patients undergoing PCI, PWA was associated with lower in-hospital procedural complications and MACCE. It's association with in-hospital MACCE should be viewed as a hypothesis-generating for future studies. Using pressure wire as a performance and a quality metric for PCI might help improve adoption in the future.

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