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

Pressure wire-derived indices are widely used to guide revascularisation of angiographically intermediate coronary lesions. While fractional flow reserve (FFR) remains the reference standard, the resting full-cycle ratio (RFR) and other non-hyperaemic indices are increasingly adopted due to their ease of use. Data on real-world outcomes with these indices in Australia remain limited.

Consecutive adults undergoing coronary angiography with pressure wire assessment between July 2021 and June 2024 at a tertiary centre in Sydney were included. Patient demographics, procedural data and outcomes were retrieved from hospital records. The primary end point was major adverse cardiac and cerebrovascular events (MACCE: all-cause mortality, non-fatal myocardial infarction, stroke or target vessel failure) during follow-up to June 2025.

The study included 381 patients (mean age 64.6 years, 67% male) in whom 476 vessels were interrogated. Over a median follow-up of 460 days (IQR 232-766 days), MACCE occurred in 24 patients (6.3%), including 14 events within the first 12 months. Among those who had revascularisation deferred after negative pressure wire assessment, 6.3% developed MACCE. Outcomes were similar between those where revascularisation decisions were based on RFR or FFR alone and those who had both modalities (log-rank p=0.98). Discordance between RFR and FFR measurements were present in 21.7%.

In a contemporary Australian cohort, revascularisation guided by pressure wire assessment was associated with low adverse event rates. Non-hyperaemic indices like RFR are a pragmatic tool in clinical practice. Discordance between pressure wire indices remains clinically relevant and warrants further prospective research.