Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease

Mizukami, Takuya; Sonck, Jeroen; Sakai, Koshiro; Ko, Brian; Mæng, Michael; Otake, Hiromasa; Koo, Bon Kwon; Nagumo, Sakura; Nørgaard, Bjarne Linde; Leipsic, Jonathon; Shinke, Toshiro; Munhoz, Daniel; Mileva, Niya; Belmonte, Marta; Ohashi, Hirofumi; Barbato, Emanuele; Johnson, Nils P.; Bruyne, Bernard De; Collet, Carlos

doi:10.1161/jaha.122.026960

Cited by 22 publications

(7 citation statements)

References 29 publications

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“…MSA, an independent predictor of stent failure, was significantly smaller in vessels with low PPG (diffuse disease). 15 , 30 Interestingly, this was not driven by vessel size, because reference vessel diameter was similar between vessels with focal or diffuse disease. It can be hypothesized that the association between diffuse hemodynamic disease and small MSA was partly mediated by the underlying plaque.…”

Section: Discussionmentioning

confidence: 98%

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Intravascular Imaging Findings After PCI in Patients With Focal and Diffuse Coronary Artery Disease

Ohashi,

Mizukami,

Sonck

et al. 2024

JAHA

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Background Following percutaneous coronary intervention (PCI), optical coherence tomography provides prognosis information. The pullback pressure gradient is a novel index that discriminates focal from diffuse coronary artery disease based on fractional flow reserve pullbacks. We sought to investigate the association between coronary artery disease patterns, defined by coronary physiology, and optical coherence tomography after stent implantation in stable patients undergoing PCI. Methods and Results This multicenter, prospective, single‐arm study was conducted in 5 countries (NCT03782688). Subjects underwent motorized fractional flow reserve pullbacks evaluation followed by optical coherence tomography‐guided PCI. Post‐PCI optical coherence tomography minimum stent area, stent expansion, and the presence of suboptimal findings such as incomplete stent apposition, stent edge dissection, and irregular tissue protrusion were compared between patients with focal versus diffuse disease. Overall, 102 patients (105 vessels) were included. Fractional flow reserve before PCI was 0.65±0.14, pullback pressure gradient was 0.66±0.14, and post‐PCI fractional flow reserve was 0.88±0.06. The mean minimum stent area was 5.69±1.99 mm 2 and was significantly larger in vessels with focal disease (6.18±2.12 mm 2 versus 5.19±1.72 mm 2 , P =0.01). After PCI, incomplete stent apposition, stent edge dissection, and irregular tissue protrusion were observed in 27.6%, 10.5%, and 51.4% of the cases, respectively. Vessels with focal disease at baseline had a lower prevalence of incomplete stent apposition (11.3% versus 44.2%, P =0.002) and more irregular tissue protrusion (69.8% versus 32.7%, P <0.001). Conclusions Baseline coronary pathophysiological patterns are associated with suboptimal imaging findings after PCI. Patients with focal disease had larger minimum stent area and a higher incidence of tissue protrusion, whereas stent malapposition was more frequent in patients with diffuse disease.

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Section: Discussionmentioning

confidence: 98%

“…Optimal procedural results were defined as MSA >5.5 mm 2 and post‐PCI FFR >0.90. 15 Cardiac biomarkers and an ECG were collected 6 to 24 hours after the procedure. To allow for comparison among different troponin assays, values were normalized to the assay‐specific 99th percentile upper reference limit.…”

Section: Methodsmentioning

confidence: 99%

Intravascular Imaging Findings After PCI in Patients With Focal and Diffuse Coronary Artery Disease

Ohashi,

Mizukami,

Sonck

et al. 2024

JAHA

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“…In this context, compared with wire-based physiology, QFR has a theoretical additional advantage, as it may allow to predict beforehand the functional result of the angioplasty. This could be crucial in the daily catheterization laboratory practice to detect the subgroup of lesions that will not significantly improve after PCI, avoiding overtreatment and the use of unnecessary stents (with all the procedure-related complications and the long-term risk of intra-stent restenosis) [30]. Recently, the AQVA trial demonstrated that QFR-based virtual PCI was superior to conventional angiographybased PCI at achieving an optimal post-PCI physiology result (defined as a post-PCI QFR value ≥ 0.90).…”

Section: Discussionmentioning

confidence: 99%

Validation of Quantitative Flow Ratio-Derived Virtual Angioplasty with Post-Angioplasty Fractional Flow Reserve—The QIMERA-I Study

Amat-Santos,

Marengo,

Sánchez-Luna

et al. 2023

JCDD

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Background: 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.

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“…The intervention in vessels with high PPG (focal disease and average PPG 0.80 ± 0.06) resulted in higher post-PCI FFR compared to low PPG (diffuse disease and average 0.58 ± 0.09), (0.91 ± 0.07 focal vs. 0.86 ± 0.05 diffuse group, P < 0.001), and greater stent area (6.3 ± 2.3 mm 2 vs. 5.3 ± 1.8 mm 2 , P = 0.015). The authors stated that 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] vs. area under the curve angio 0.51 [95% CI, 0.42–0.60]; P < 0.001) ( 19 ). Regarding post-PCI angina, in a sub-study of TARGET—FFR (Trial of Angiography vs. pressure-Ratio-Guided Enhancement Techniques—Fractional Flow reserve), it was shown that patients with focal disease had larger increases in FFR after PCI (0.30 ± 0.14 vs. 0.19 ± 0.12; P < 0.001) and less angina assessed by the Seattle angina questionnaire (SAQ-7) [87.1 ± 20.3 vs. 75.6 ± 24.4; mean difference = 11.5 (95% CI: 2.8–20.3); P = 0.01] compared to patients with diffuse disease assessed by PPG.…”

Section: The Methods To Evaluate Serial Stenosesmentioning

confidence: 99%

Serial stenosis assessment—can we rely on invasive coronary physiology

Ilić

Timcic

Odanovic

et al. 2023

Front. Cardiovasc. Med.

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Atherosclerosis is a widespread disease affecting coronary arteries. Diffuse atherosclerotic disease affects the whole vessel, posing difficulties in determining lesion significance by angiography. Research has confirmed that revascularization guided by invasive coronary physiology indices improves patients' prognosis and quality of life. Serial lesions can be a diagnostic challenge because the measurement of functional stenosis significance using invasive physiology is influenced by a complex interplay of factors. The use of fractional flow reserve (FFR) pullback provides a trans-stenotic pressure gradient (ΔP) for each of the lesions. The strategy of treating the lesion with greater ΔP first and then reevaluating another lesion has been advocated. Similarly, non-hyperemic indices can be used to assess the contribution of each stenosis and predict the effect of lesion treatment on physiology indices. Pullback pressure gradient (PPG) integrates physiological variables of coronary pressure along the epicardial vessel and characteristics of discrete and diffuse coronary stenoses into a quantitative index that can be used to guide revascularization. We proposed an algorithm that integrates FFR pullbacks and calculates PPG to determine individual lesion importance and to guide intervention. Computer modeling of the coronaries and the use of non-invasive FFR measurement together with mathematical algorithms for fluid dynamics can make predictions of lesion significance in serial stenoses easier and provide practical solutions for treatment. All these strategies need to be validated before widespread clinical use.

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Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease

Cited by 22 publications

References 29 publications

Intravascular Imaging Findings After PCI in Patients With Focal and Diffuse Coronary Artery Disease

Intravascular Imaging Findings After PCI in Patients With Focal and Diffuse Coronary Artery Disease

Validation of Quantitative Flow Ratio-Derived Virtual Angioplasty with Post-Angioplasty Fractional Flow Reserve—The QIMERA-I Study

Serial stenosis assessment—can we rely on invasive coronary physiology

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