Intracoronary pullback increased optimal medical therapy adoption to 51.5% vs 40.9%, reduced PCI rates to 27.1% vs 36.3%, without increasing 1-year MACE.
Does intracoronary pullback measurement influence treatment strategy and affect 1-year clinical outcomes in patients with significant LAD disease?
Intracoronary pullback measurement in functionally significant LAD disease favors a conservative treatment strategy (OMT over PCI) without increasing 1-year MACE, though it was associated with higher all-cause mortality in this retrospective cohort.
Background: Optimal management of coronary artery disease (CAD) requires tailoring treatment strategies to lesion characteristics. Intracoronary pullback enables hemodynamic mapping of coronary lesions, potentially improving therapeutic decision-making, particularly in distinguishing focal from diffuse disease. Objectives: To evaluate how pullback measurement influences overall treatment strategy—optimal medical therapy (OMT), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG)—in patients with significant CAD. Methods: We conducted a retrospective, multicenter cohort study including 842 patients with stable angina, unstable angina, or non-ST-elevation myocardial infarction (NSTEMI) and functionally significant left anterior descending artery (LAD) disease. Patients were stratified into two groups: one group (PB group, n = 561) had pullback measurement, and the other (Conventional group, n = 281) not. Outcomes included treatment strategy, major adverse cardiovascular events (MACE), and all-cause mortality at 1 year. Results: Pullback led to more Heart Team discussions (66.3% vs. 58.7%; p = 0.033), greater adoption of OMT (51.5% vs. 40.9%; p = 0.004), and lower PCI rates (27.1% vs. 36.3%; p = 0.007). CABG rates remained unaffected. Pullback independently increased the odds of OMT and reduced the odds of PCI (OR = 0.58, p = 0.003), while three-vessel disease strongly predicted CABG (OR = 2.51; p < 0.001). At 1 year, the PB group had higher mortality (4.3% vs. 1.1%, p = 0.013), but similar MACE compared to the Conventional group. However, clinical outcomes did not differ between treatment groups. Conclusions: Intracoronary pullback favours a conservative treatment strategy. MACE rates are not increased at 1 year.
Bova et al. (2026) studied this question. Intracoronary pullback increased optimal medical therapy adoption to 51.5% vs 40.9%, reduced PCI rates to 27.1% vs 36.3%, without increasing 1-year MACE.