Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease
Year: 2022
Type: article
Study design: Observational Study
Abstract: Background Coronary artery disease (CAD) patterns play an essential role in the decision‐making process about revascularization. The pullback pressure gradient (PPG) quantifies CAD patterns as either focal or diffuse based on fractional flow reserve (FFR) pullbacks. The objective of this study was to evaluate the impact of CAD patterns on acute percutaneous coronary intervention (PCI) results considered surrogates of clinical outcomes. Methods and Results This was a prospective, multicenter study of patients with hemodynamically significant CAD undergoing PCI. Motorized FFR pullbacks and optical coherence tomography (OCT) were performed before and after PCI. Post‐PCI FFR >0.90 was considered an optimal result. Focal disease was defined as PPG >0.73 (highest PPG tertile). Overall, 113 patients (116 vessels) were included. Patients with focal disease were younger than those with diffuse CAD (61.4±9.9 versus 65.1±8.7 years, P =0.042). PCI in vessels with high PPG (focal CAD) resulted in higher post‐PCI FFR (0.91±0.07 in the focal group versus 0.86±0.05 in the diffuse group, P <0.001) and larger minimal stent area (6.3±2.3 mm 2 in focal versus 5.3±1.8 mm 2 in diffuse CAD, P =0.015) compared withvessels with low PPG (diffuse CAD). The PPG was associated with the change in FFR after PCI ( R 2 =0.51, P <0.001). The PPG significantly improved the capacity to predict optimal PCI results compared with an angiographic assessment of CAD patterns (area under the curve PPG 0.81 [95% CI, 0.73–0.88] versus area under the curve angio 0.51 [95% CI, 0.42–0.60]; P <0.001). Conclusions PCI in vessels with focal disease defined by the PPG resulted in greater improvement in epicardial conductance and larger minimal stent area compared with diffuse disease. PPG, but not angiographically defined CAD patterns, distinguished patients attaining superior procedural outcomes. Registration URL: https://clinicaltrials.gov/ct2/show/NCT03782688
Authors: Takuya Mizukami, Jeroen Sonck, Koshiro Sakai, Brian Ko, Michael Maeng, Hiromasa Otake, Bon‐Kwon Koo, Sakura Nagumo, Bjarne L. Nørgaard, Jonathon Leipsic, Toshiro Shinke, Daniel Munhoz, Niya Mileva, Marta Belmonte, Hirofumi Ohashi, Emanuele Barbato, Nils P. Johnson, Bernard De Bruyne, Carlos Collet
Institutions: SHOWA Medical University, Onze Lieve Vrouwziekenhuis Hospital, Monash Health, Monash University, Aarhus University Hospital, Kobe University, Seoul National University, Seoul National University Hospital, SHOWA Medical University Fujigaoka Hospital, University of British Columbia, Universidade Estadual de Campinas (UNICAMP), Federico II University Hospital, University of Naples Federico II, Alexandrovska Hospital, University of Milan, Aichi Medical University, Aichi Medical University Hospital, Memorial Hermann, The University of Texas Health Science Center at Houston, Centre Hospitalier Universitaire Vaudois
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,700
OpenAlex ID: W4310241098