The following is a summary of “Influence of Pathophysiological Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes,” published in the May 2024 issue of Cardiology by Collet et al.
Diffuse coronary artery disease (CAD) affects the safety and effectiveness of percutaneous coronary interventions (PCI). Using fractional flow reserve (FFR) pullbacks, we can measure CAD patterns, including pullback pressure gradient (PPG), to understand their impact on procedures.
Researchers conducted a prospective study to verify if PPG measurements can predict the best way to revascularize and improve procedural outcomes.
They used multicenter studies, enrolling patients with at least one epicardial lesion needing PCI due to an FFR ≤0.80. Manual FFR pullbacks were employed to calculate PPG. The primary outcome of optimal revascularization was defined as achieving a post-PCI FFR ≥ 0.88.
The results showed that 993 patients were studied with 1,044 vessels; the mean FFR was (0.68±0.12), PPG (0.62±0.17), and post-PCI FFR (0.87±0.07). PPG strongly correlated with FFR change after PCI (r=0.65, 95% CI 0.61-0.69, P<0.001) and predicted optimal revascularization well (AUC 0.82, 95% CI 0.79-0.84, P<0.001). FFR alone did not predict outcomes (AUC 0.54, 95% CI 0.50-0.57). Treatment decisions were influenced by PPG in 14% of patients, redirecting them from PCI to alternative treatment. Low PPG (<0.62) increased myocardial infarction risk compared to those with focal disease (OR 1.71, 95% CI: 1.00-2.97).
Investigators concluded that CAD patterns significantly impact PCI outcomes. PPG proved highly predictive of optimal revascularization and offered additional insights beyond FFR measurements.
Source: ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.069450
The post Impact of Coronary Artery Disease Patterns on Immediate PCI Results first appeared on Physician's Weekly.