Invasive coronary physiology assessment - safety of pressure wire study as a diagnostic tool at a district general hospital

Abstract

Introduction Pressure wire study (PWS) is a well-established tool for the assessment of the haemodynamic significance of intermediate coronary artery stenoses (40–90%). This, according to the 2018 ESC myocardial revascularization guidelines, has Class IA indication when evidence of ischaemia is not present. It can be used to calculate the fractional flow reserve (FFR), instantaneous wave-free ratio (iFR) or resting full cycle ratio (RFR) to guide revascularization decisions, with similar diagnostic accuracy between the tests. Despite the above, the utilization of PWS varies across the U.K., as reflected in the recent BCIS annual data. One possible explanation might be the fact that there are still numerous centres in the U.K, where diagnostic only coronary angiography lists take place, precluding the use of PWS at the same sitting. In our study, we aimed to review the safety of PWS as an invasive diagnostic tool and determine whether it could be incorporated in diagnostic only lists for the assessment of coronary stenoses.