# The impact of pullback measurement on treatment decision in significant coronary artery disease: Insights from a retrospective multicentric study

## TL;DR

This study shows that using pullback measurements in coronary artery disease leads to more conservative treatment choices, with no increase in major adverse events after one year.

## Contribution

The study provides new evidence on how pullback measurements influence treatment decisions and outcomes in coronary artery disease.

## Key findings

- Pullback measurement increased Heart Team discussions and OMT use while reducing PCI rates.
- The PB group had higher 1-year mortality but similar MACE compared to the conventional group.
- Three-vessel disease was a strong predictor of CABG, independent of pullback use.

## Abstract

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.

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.

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.

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.

Intracoronary pullback favours a conservative treatment strategy. MACE rates are not increased at 1 year.