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Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes

Collet C 1 , Munhoz D 1 , Mizukami T 1 , Sonck J 1 , Matsuo H 2 , Shinke T 3 Show all authors , Ando H 4 , Ko B 5 , Biscaglia S 6 , Rivero F 7 , Engstrøm T 8 , Arslani K 8 , Leone AM 9 , van Nunen LX 10 , Fearon WF 11 , Christiansen EH 12 , Fournier S 13 , Desta L 14 , Yong A 15 , Adjedj J 16 , Escaned J 17 , Nakayama M 18 , Eftekhari A 19 , Zimmermann FM 20 , Sakai K 1 , Storozhenko T 1 , da Costa BR 21 , Campo G 6 , West NEJ 22 , De Potter T 1 , Heggermont W 1 , Buytaert D 1 , Bartunek J 1 , Berry C 23 , Collison D 23 , Johnson T 24 , Amano T 4 , Perera D 25 , Jeremias A 26 , Ali Z 26 , Pijls NHJ 20 , De Bruyne B 1 , Johnson NP 27

Affiliations 

  • 1 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium (C.C., D.M., T.M., J.S., K.S., T. Storozhenko, T.D.P., W.H., D.B., J.B., B.D.B.)
  • 2 Department of Cardiovascular Medicine, Gifu Heart Center, Japan (H.M.)
  • 3 Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (T. Shinke, K.S.)
  • 4 Department of Cardiology, Aichi Medical University, Japan (H.A., T.A.)
  • 5 Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia (B.K.)
  • 6 Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Italy (S.B., G.C.)
  • 7 Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain (F.R.)
  • 8 Rigshospitalet, University of Copenhagen, Denmark (T.E., K.A.)
  • 9 Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (A.M.L.)
  • 10 Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (L.X.v.N.)
  • 11 Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine and VA Palo Alto Health Care System, Palo Alto, CA (W.F.F.)
  • 12 Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (E.H.C.)
  • 13 Department of Cardiology, University Hospital of Lausanne, Switzerland (S.F., B.D.B.)
  • 14 Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden (L.D.)
  • 15 Concord Repatriation General Hospital, University of Sydney, New South Wales, Australia (A.Y.)
  • 16 Department of Cardiology, Arnault Tzanck Institute Saint Laurent du Var, France (J.A.)
  • 17 Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid, Spain (J.E.)
  • 18 Department of Cardiology, Tokyo D Tower Hospital, Japan (M.N.)
  • 19 Department of Cardiology, Aalborg University Hospital, Denmark (A.E.)
  • 20 Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z., N.H.J.P.)
  • 21 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK (B.R.d.C.)
  • 22 Abbott Vascular, Santa Clara, CA (N.E.J.W.)
  • 23 School of Cardiovascular and Metabolic Health, University of Glasgow, UK (C.B., D.C.)
  • 24 University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK (T.J.)
  • 25 School of Cardiovascular Medicine and Sciences, St Thomas' Hospital Campus, King's College London, UK (D.P.)
  • 26 St Francis Hospital and Heart Center, Roslyn, NY (A.J., Z.A.)
  • 27 Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX (N.P.J.)
Circulation, 2024 Aug 20;150(8):586-597.
PMID: 38742491 DOI: 10.1161/CIRCULATIONAHA.124.069450

Abstract

BACKGROUND: Diffuse coronary artery disease affects the safety and efficacy of percutaneous coronary intervention (PCI). Pathophysiologic coronary artery disease patterns can be quantified using fractional flow reserve (FFR) pullbacks incorporating the pullback pressure gradient (PPG) calculation. This study aimed to establish the capacity of PPG to predict optimal revascularization and procedural outcomes.

METHODS: This prospective, investigator-initiated, single-arm, multicenter study enrolled patients with at least one epicardial lesion with an FFR ≤0.80 scheduled for PCI. Manual FFR pullbacks were used to calculate PPG. The primary outcome of optimal revascularization was defined as an FFR ≥0.88 after PCI.

RESULTS: A total of 993 patients with 1044 vessels were included. The mean FFR was 0.68±0.12, PPG 0.62±0.17, and the post-PCI FFR was 0.87±0.07. PPG was significantly correlated with the change in FFR after PCI (r=0.65 [95% CI, 0.61-0.69]; P<0.001) and demonstrated excellent predictive capacity for optimal revascularization (area under the receiver operating characteristic curve, 0.82 [95% CI, 0.79-0.84]; P<0.001). FFR alone did not predict revascularization outcomes (area under the receiver operating characteristic curve, 0.54 [95% CI, 0.50-0.57]). PPG influenced treatment decisions in 14% of patients, redirecting them from PCI to alternative treatment modalities. Periprocedural myocardial infarction occurred more frequently in patients with low PPG (<0.62) compared with those with focal disease (odds ratio, 1.71 [95% CI, 1.00-2.97]).

CONCLUSIONS: Pathophysiologic coronary artery disease patterns distinctly affect the safety and effectiveness of PCI. PPG showed an excellent predictive capacity for optimal revascularization and demonstrated added value compared with an FFR measurement.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04789317.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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