International journal of cardiology. Heart & vasculature · 2026
The impact of pullback measurement on treatment decision in significant coronary artery disease: Insights from a retrospective multicentric study.
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Bova Roberto, Betti Matteo, Heuts Samuel, Vriesendorp Pieter A, Ijsselmuiden Alexander J J, Rasoul Saman, Ilhan Mustafa, Vainer Jindra, Theunissen Ralph A L J, Veenstra Leo F, Winkler Patty, Stein Mera, Ruiters Alexander, Slegers Daniek P J, van 't Hof Arnoud W J, Lux Arpad
Аннотация
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.
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.