Prognostic value of post-percutaneous coronary intervention diastolic pressure ratio

Abstract

Aim To evaluate the distribution of a generic diastolic pressure ratio (dPR) after angiographically successful percutaneous coronary intervention (PCI) and to assess its association with the 2‑year incidence of target vessel failure (TVF), defined as a composite of cardiac mortality, target vessel revascularisation, target vessel myocardial infarction and stent thrombosis. Methods The dPR SEARCH study is a post hoc analysis of the prospective single-centre FFR-SEARCH registry, in which physiological assessment was performed after angiographically successful PCI in a total of 1000 patients, using a dedicated microcatheter. dPR was calculated offline with recently validated software in a subset of 735 patients. Results Mean post-PCI dPR was 0.95 ± 0.06. Post-PCI dPR was ≤ 0.89 in 15.2% of the patients. The cumulative incidence of TVF at 2‑year follow-up was 9.4% in patients with a final post-PCI dPR ≤ 0.89 as compared to 6.1% in patients with a post-PCI dPR > 0.89 (adjusted hazard ratio [HR] for dPR ≤ 0.89: 1.53; 95% CI 0.74–3.13; p = 0.249). dPR ≤ 0.89 was associated with significantly higher cardiac mortality at 2 years; adjusted HR 2.40; 95% CI 1.01–5.68; p = 0.047. Conclusions In a real-world setting, despite optimal angiographic PCI results, 15.2% of the patients had a final post-PCI dPR of ≤ 0.89, which was associated with a higher incidence of TVF and a significantly higher cardiac mortality rate.

Pressure gradient post-percutaneous coronary intervention: beyond angiography

“…Since then, it is argued that maximal hyperaemia is essential in order to detect the smaller pressure gradients post-PCI, and the adoption of post-PCI physiological assessment is hampered by the increased procedural time and effort. However, the findings by Masdjedi et al [2] show that the easily available resting dPR also has prognostic value in the assessment of post-PCI results. In this respect, it is important to mention some pathophysiological mechanisms that could explain the association between abnormal resting pressure gradients and clinical outcomes.…”

“…Only in recent years have studies regarding the importance of functional assessment of CAD emerged, and clinical practice has slowly been adapting to a more physiology-guided approach. In this issue of the Netherlands Heart Journal, the article by Masdjedi et al [2] importantly adds to the current literature with a post hoc analysis of the FFR-SEARCH registry regarding the prognostic value of the resting diastolic pressure ratio (dPR) post-percutaneous coronary intervention (PCI). In their study, they found that approximately 15% of the patients with optimal angiographic PCI results had an abnormal post-PCI dPR (< 0.89).…”

“…However, the findings by Masdjedi et al. [ 2 ] show that the easily available resting dPR also has prognostic value in the assessment of post-PCI results. In this respect, it is important to mention some pathophysiological mechanisms that could explain the association between abnormal resting pressure gradients and clinical outcomes.…”

“…Masdjedi et al. [ 2 ] add to the evolving literature and importantly show that resting pressure ratios are also associated with impaired clinical prognosis. Hereby, the application of post-PCI assessment beyond angiographic results—with easily available resting pressure gradients or other non-hypaeremic modalities—is facilitated and enables future optimisation of PCI therapy.…”