The Usefulness of Coregistration with iFR in Tandem or Long Diffuse Coronary Lesions: The iLARDI Randomized Clinical Trial

Background. Despite technical advancements, patients with sequential or diffuse coronary lesions undergoing percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events at follow-up. We aimed to analyze the utility of a SyncVision/iFR (S-iFR)-guided PCI strategy versus an angiography-guided strategy in patients with this type of lesions. Methods. Randomized, multicenter, controlled, and open-label trial to compare S-iFR versus angiography-guided PCI in patients with sequential or diffuse angiographic coronary stenosis (ClinicalTrials.gov identifier: NCT04283734). The primary endpoint was the implanted stent length. The main secondary endpoint was targeting vessel failure (TVF) at one year. Results. A total of 100 patients underwent randomization, with 49 patients assigned to the S-iFR group and 51 to the angiography-guided PCI group. There were no differences between groups regarding clinical and anatomical characteristics. The baseline iFR was 0.71 } 0.16 vs. 0.67 } 0.19 (p = 0.279) in the S-iFR and angiography group, respectively. The mean lesion length was 42.3 } 12 mm and 39.8 } 12 (p = 0.297). The implanted stent length was 32.7 } 17.2 mm in the S-iFR group and 43.1 } 14.9 mm in the angiography group (mean difference, −10.4 mm; 95% confidence interval [CI], −16.9 to −4.0; p = 0.002). At one year, target vessel failure (TVF) occurred in four patients: three (6.1%) in the S-iFR group vs. one (1.9%) in the angiography group (p = 0.319). Conclusions. Among patients with sequential or long diffuse coronary lesions, a S-iFR-guided PCI strategy resulted in a reduction of the total stent length compared to an angiography-guided PCI strategy. A nonsignificant increase in TVF was observed in the S-iFR group

Use of a multimedia classroom with connection to Hemodynamic Laboratories for the comprehensive practical training of the medical student in the area of Cardiology

La aplicabilidad práctica de los conocimientos teóricos adquiridos durante las clases magistrales constituye una parte esencial en la formación del futuro médico. Sin embargo, las prácticas en quirófanos y en Laboratorios de Cardiología Intervencionista son deficientes. El aforo es limitado por motivos de seguridad. Además, la visibilidad es reducida y la comunicación entre el operador y el alumno puede ser difícil por la presencia del enfermo. Desarrollar un nuevo modelo de prácticas clínicas complementarias a las convencionales ayudaría a que los alumnos adquieran la capacitación básica requerida. El objetivo principal de este proyecto es conseguir que los alumnos obtengan una visión práctica e integral del paciente cardiológico, proporcionando las herramientas necesarias a través de un Aula Multimedia con conexión directa a los Laboratorios de Hemodinámica y a las bases de datos clínicos de la UGC de Cardiología del Hospital Universitario Reina Sofía. Esta acción de Innovación Docente pretende mejorar los procesos de enseñanza-aprendizaje de la Cardiología y realizar una simulación clínica del proceso de diagnóstico, tratamiento y alta hospitalaria de un paciente cardiológico. Adicionalmente, este sistema podría proporcionar al docente una herramienta objetiva para la evaluación de las prácticas clínicas de estudiantes del área de Ciencias de la Salud.The practical applicability of the theoretical knowledge acquired during the lectures constitutes an essential part of the training of the future doctor. However, the practices in operating rooms and Interventional Cardiology Laboratories are deficient. Capacity is limited for security reasons. In addition, visibility is reduced, and communication between the operator and the student can be difficult due to the patient's presence. Developing a new model of clinical practices complementary to conventional ones would help students acquire the basic training required. The main objective of this project is to ensure that students obtain a realistic and comprehensive view of the cardiology patient, providing the necessary tools through a Multimedia Classroom with a direct connection to the Hemodynamic Laboratories and the clinical databases of the UGC of Cardiology of the Reina Sofía University Hospital. This Teaching Innovation action aims to improve the teaching-learning processes of Cardiology and carry out a clinical simulation of the process of diagnosis, treatment, and hospital discharge of a cardiac patient. Additionally, this system could provide the teacher with an objective tool for evaluating the clinical practices of students in the area of Health Sciences

Validation of quantitative flow ratio-derived virtual angioplasty with post-angioplasty fractional flow reserve—the QIMERA-I study

Producción CientíficaBackground: Quantitative flow ratio (QFR) virtual angioplasty with pre-PCI residual QFR showed better results compared with an angiographic approach to assess post-PCI functional results. However, correlation with pre-PCI residual QFR and post-PCI fractional flow reserve (FFR) is lacking. Methods: A multicenter prospective study including consecutive patients with angiographically 50–90% coronary lesions and positive QFR results. All patients were evaluated with QFR, hyperemic and non-hyperemic pressure ratios (NHPR) before and after the index PCI. Pre-PCI residual QFR (virtual angioplasty) was calculated and compared with post-PCI fractional flow reserve (FFR), QFR and NHPR. Results: A total of 84 patients with 92 treated coronary lesions were included, with a mean age of 65.5 ± 10.9 years and 59% of single vessel lesions being the left anterior descending artery in 69%. The mean vessel diameter was 2.82 ± 0.41 mm. Procedural success was achieved in all cases, with a mean number of implanted stents of 1.17 ± 0.46. The baseline QFR value was 0.69 ± 0.12 and baseline FFR and NHPR were 0.73 ± 0.08 and 0.82 ± 0.11, respectively. Mean post-PCI FFR increased to 0.87 ± 0.05 whereas residual QFR had been estimated as 0.95 ± 0.05, showing poor correlation with post-PCI FFR (0.163; 95% CI:0.078–0.386) and low diagnostic accuracy (30.9%, 95% CI:20–43%). Conclusions: In this analysis, the results of QFR-based virtual angioplasty did not seem to accurately correlate with post-PCI FFR