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

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

Publication Date

12-6-2022

Journal

Journal of the American Heart Association

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 mm² in focal versus 5.3±1.8 mm² 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

Keywords

Humans, Percutaneous Coronary Intervention, Coronary Artery Disease, Fractional Flow Reserve, Myocardial, Prospective Studies, CAD patterns, diffuse disease, percutaneous coronary interventions, pullback pressure gradient, Revascularization, Percutaneous Coronary Intervention, Coronary Circulation

DOI

10.1161/JAHA.122.026960

PMID

36444858

PMCID

PMC9851458

PubMedCentral® Posted Date

12-6-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes