How often do patients leave the cath lab with residual ischemia—and can physiologic guidance change outcomes?
In this discussion, Dr. Chris Brown and Dr. Christian McNeely review insights from the DEFINE GPS Trial, where PCI guided by pressure wire co-registration was compared with angiography alone.
Key highlights:
- Why 20% of patients left the lab with residual ischemia in DEFINE PCI
- How FFR/iFR pullback and co-registration create a physiologic roadmap for stenting
- Trial design, enrollment (2,100 patients), and endpoints: MACE at 1–2 years
- Surprising cases where physiology overturned angiographic impressions
- Calcium, long lesions, and the limits of angiography alone
- When to trust physiology vs imaging—IVUS/IVL integration
- The future role of co-registration software in routine PCI
This is a must-watch for interventional cardiologists looking to integrate objective physiologic data into daily practice.
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00:00 – Intro & guest background
00:39 – Define GPS trial design & objectives
01:17 – Residual ischemia: lessons from Define PCI
02:23 – Co-registration system explained
03:09 – Inclusion criteria & patient population
03:53 – Endpoints: MACE at 1–2 years
04:07 – Enrollment: 2,100 patients, top enrolling sites
04:25 – Why angiography alone misses physiology
05:12 – Standard PCI workflow vs physiologic pullback
06:30 – Case 1: circumflex calcification & LAD ischemia
07:41 – Co-registration mechanics step-by-step
09:12 – Post-PCI IFR goals & physiologic success
11:31 – IVUS co-registration and stent sizing pearls
12:46 – Calcium, long lesions & turbulence effects
13:43 – Taking subjectivity out of angiography
15:22 – Physiology + imaging: additive or redundant?
16:43 – Aggressive stent sizing & perforation risk
17:28 – Case 2: non-STEMI with PDA & focal circ lesion
18:51 – Pullback showing ischemia dots at stenosis
20:10 – Why physiology prevented unnecessary stenting
21:49 – Which lesions should we defer vs treat?
22:17 – Looking ahead: Define GPS trial results (2026–27)
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