Design and Rationale of the RIPCORD 2 Trial (Does Routine Pressure Wire Assessment Influence Management Strategy at Coronary Angiography for Diagnosis of Chest Pain?) A Randomized Controlled Trial to Compare Routine Pressure Wire Assessment With Conventional Angiography in the Management of Patients With Coronary Artery Disease

摘要

BACKGROUND: Investigation of anginal chest pain has traditionally involved either assessment of the coronary anatomy by angiography or noninvasive testing for reversible ischemia. Invasive pressure wire assessment at the time of angiography offers information on both anatomy and physiology. Fractional flow reserve-guided percutaneous coronary intervention is associated with lower resource utilization and improved clinical outcome compared with angiographic guidance alone. However, the value of routine fractional flow reserve of all major coronary vessels at the time of diagnostic angiography has not been established in a randomized trial despite persuasive observational data. A change in practice to routine fractional flow reserve assessment of all major vessels during diagnostic angiography would require evidence not just of clinical benefit but also of cost effectiveness. This randomized trial aims to test that strategy.