Transstenotic coronary pressure gradient measurement in humans: In vitro and in vivo evaluation of a new pressure monitoring angioplasty guide wire

Q: What are the key findings of this study?

Mean transstenotic pressure gradients recorded with a novel 0.015-in. fluid-filled guide wire decreased from 30 mm Hg before to 3 mm Hg after coronary angioplasty (p<0.01).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Coronary stenosis (n=37). Intervention: 0.015-in. fluid-filled guide wire for pressure measurement vs. Before angioplasty. Primary outcome: Mean transstenotic pressure gradient (p=< 0.01).

Q: What does this research mean for the field?

A 0.015-inch fluid-filled guide wire enables accurate and feasible measurement of mean transstenotic coronary pressure gradients without substantially altering hemodynamics except in very tight lesions. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

Evaluate the feasibility and accuracy of coronary pressure measurements using a novel 0.015-inch fluid-filled guide wire and determine the wire's effect on stenosis hemodynamics.

Bernard De Bruyne; Walter J. Paulus; Pascal J.M.J Vantrimpont; Stanislas U. Sys; Guy Robert Heyndrickx; Nico H.J. Pijls

doi:10.1016/0735-1097(93)90825-l

July 1, 1993Journal of the American College of CardiologyOpen Access

Transstenotic coronary pressure gradient measurement in humans: In vitro and in vivo evaluation of a new pressure monitoring angioplasty guide wire

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Key result

Novel pressure wire records ~27 mmHg transstenotic gradient reduction after coronary angioplasty.

P<0.01
n=37

Why the study?

Measurements of the transstenotic pressure gradient are advocated to assess coronary angioplasty results but are unreliable with angioplasty catheters.

Does a novel 0.015-in. fluid-filled guide wire accurately measure transstenotic pressure gradients compared to actual pressure and quantitative coronary angiography?

Key Points

Evaluate the feasibility and accuracy of coronary pressure measurements using a novel 0.015-inch fluid-filled guide wire and determine the wire's effect on stenosis hemodynamics.
Tested five fluid-filled guide wires in vitro for frequency response and hydrostatic accuracy, as well as pressure gradients across varying stenosis severity in a 4-mm reference model.
Measured transstenotic pressure gradients before and after coronary angioplasty in 37 patients, comparing results to quantitative coronary angiography metrics.
Guide wire pressure recordings correlated strongly with true pressure (r = 0.98, underestimation -3 ± 5%), with wire-induced gradient overestimation (> 20%) occurring only in severe stenoses (> 90% area reduction).
Lesion crossing was achieved in 97% of patients (36/37), and continuous pressure recordings were obtained in 94% of cases (34/36).
Mean transstenotic pressure gradient decreased from 30 ± 19 mm Hg before angioplasty to 3 ± 5 mm Hg after angioplasty (p < 0.01), correlating curvilinearly with percent area stenosis (r² = 0.67).

Study Design

Type

Observational (n=37)

Structured PICO

Does a novel 0.015-in. fluid-filled guide wire accurately measure transstenotic pressure gradients compared to actual pressure and quantitative coronary angiography?

P

Population

37 patients undergoing coronary angioplasty evaluated for transstenotic pressure gradients before and after the procedure.

E

Exposure

Transstenotic coronary pressure gradient measurement using a novel 0.015-in. (0.038 cm) fluid-filled guide wire connected to a conventional pressure transducer

C

Comparator

Quantitative coronary angiography (obstruction area and percent area stenosis) and actual hydrostatic pressure (in vitro)

O

Outcome

Feasibility and accuracy of coronary pressure measurements, and the effect of the guide wire itself on stenosis hemodynamicssurrogate

Main Result

Absolute Event Rate: 3% vs 30%

p-value: p=< 0.01

Limitations

Phasic pressure recordings were precluded by a long time constant of 16 +/- 4 s.
The presence of the guide wire produced a significant overestimation (> 20%) of the pressure decrease in cases of tight stenosis (> 90% area reduction).

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Implication

A 0.015-in. fluid-filled guide wire can accurately and reliably measure mean transstenotic pressure gradients, facilitating functional assessment of coronary stenoses and postangioplasty results.

Abstract

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Discussion

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Cite This Study

Bruyne et al. (1993) conducted an observational in Coronary stenosis (n=37). 0.015-in. fluid-filled guide wire for pressure measurement vs. Before angioplasty was evaluated on Mean transstenotic pressure gradient (p=< 0.01). Mean transstenotic pressure gradients recorded with a novel 0.015-in. fluid-filled guide wire decreased from 30 mm Hg before to 3 mm Hg after coronary angioplasty (p<0.01).

synapsesocial.com/papers/6acf69b23316c606f341f9dd https://doi.org/10.1016/0735-1097(93)90825-l

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Transstenotic coronary pressure gradient measurement in humans: In vitro and in vivo evaluation of a new pressure monitoring angioplasty guide wire

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Transstenotic coronary pressure gradient measurement in humans: In vitro and in vivo evaluation of a new pressure monitoring angioplasty guide wire

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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