Outcomes Selected by Pressure Wire in Coronary Artery Revascularisation: The OSCAR Study

Area of Science:

• Cardiovascular medicine
• Interventional cardiology
• Medical technology assessment

Background:

• Pressure wire-derived indices guide revascularisation of intermediate coronary lesions.
• Fractional flow reserve (FFR) is the standard, but non-hyperaemic indices like resting full-cycle ratio (RFR) are gaining popularity due to ease of use.
• Real-world outcome data for these indices in Australia are limited.

Purpose of the Study:

• To evaluate real-world outcomes of revascularisation guided by pressure wire assessment in an Australian cohort.
• To compare outcomes between different pressure wire indices, including RFR and FFR.
• To assess the incidence of major adverse cardiac and cerebrovascular events (MACCE) following deferred revascularisation.

Main Methods:

• A consecutive series of adult patients undergoing coronary angiography with pressure wire assessment in Sydney were included.
• Data on demographics, procedures, and MACCE (all-cause mortality, MI, stroke, target vessel failure) were collected.
• Median follow-up was 460 days, with primary endpoint assessed up to June 2025.

Main Results:

• 381 patients (476 vessels) were analyzed; 6.3% experienced MACCE over median follow-up.
• Among patients with deferred revascularisation, 6.3% developed MACCE.
• Outcomes were similar regardless of whether RFR or FFR alone, or both, guided decisions (p=0.98); 21.7% showed discordance between RFR and FFR.

Conclusions:

• Revascularisation guided by pressure wire assessment is associated with low adverse event rates in Australian patients.
• Non-hyperaemic indices like RFR are effective and pragmatic tools in clinical practice.
• Discordance between pressure wire indices is relevant and requires further prospective investigation.