Impact of Routine Invasive Physiology at Time of Angiography in Patients With Multivessel Coronary Artery Disease on Reclassi fi cation of Revascularization Strategy

OBJECTIVES This study sought to prospectively assess the impact of routine invasive physiology at the time of angiography on reclassi fi cation of therapeutic management of multivessel disease (MVD) patients, and to assess how implementation of instantaneous wave-free ratio (iFR) alters the process. BACKGROUND Routine invasive physiology in intermediate coronary lesions at the time of diagnostic angiography, primarily in patients with single-vessel disease and using fractional fl ow reserve (FFR), reclassi fi es coronary revascularization management in 26% to 44% of patients. The role of invasive physiology in patients with MVD is unclear. METHODS In 18 centers, 484 patients undergoing diagnostic angiography disclosing MVD with lesions > 40% by visual assessment were included. Investigators were asked to prospectively de fi ne their initial management strategy based on angiography and clinical information. Invasive physiology (FFR or iFR driven) was then performed and fi nal strategy de fi ned. Initial and fi nal vessel, patient, procedural, and overall management were described. Reclassi fi cation was de fi ned as the difference between initial and fi nal strategy. RESULTS The majority of patients were clinically stable (82.2%). Two- and 3-vessel disease was present in 73.3%