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This retrospective, multicenter cohort study investigated the impact of intracoronary pullback measurements on treatment decisions in 842 patients with significant left anterior descending artery (LAD) disease. The study found that pullback measurements led to increased Heart Team discussions, greater adoption of optimal medical therapy (OMT), and lower rates of percutaneous coronary intervention (PCI) compared to conventional angiography. While pullback was associated with higher 1-year mortality, MACE rates were similar between groups.
Intracoronary pullback measurements in patients with significant LAD disease are associated with a shift towards more conservative management with increased OMT and decreased PCI rates, without increasing MACE at 1 year.
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.
