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Published on: April 13, 2015
Prognostic value of post-percutaneous coronary intervention diastolic pressure ratio
K Masdjedi1, L J C van Zandvoort1, T Neleman1
1Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands.
Insights
A diastolic pressure ratio (dPR) below 0.89 after percutaneous coronary intervention (PCI) was found in 15.2% of patients. This low dPR was linked to increased target vessel failure and significantly higher cardiac mortality rates within two years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Physiological Assessment
Background:
- Percutaneous coronary intervention (PCI) aims to restore blood flow but post-procedural physiological assessment is crucial.
- The diastolic pressure ratio (dPR) is a physiological index used after PCI.
- Optimal dPR thresholds for predicting long-term outcomes after PCI are not well-established.
Purpose of the Study:
- To determine the distribution of the diastolic pressure ratio (dPR) after successful PCI.
- To evaluate the association between post-PCI dPR and the 2-year incidence of target vessel failure (TVF).
Main Methods:
- A post hoc analysis of the prospective FFR-SEARCH registry.
- Physiological assessment using a microcatheter in 1000 patients post-PCI.
- Offline dPR calculation in 735 patients using validated software.
Main Results:
- The mean post-PCI dPR was 0.95 ± 0.06.
- 15.2% of patients had a post-PCI dPR ≤ 0.89.
- Patients with dPR ≤ 0.89 showed a higher 2-year incidence of TVF (9.4% vs 6.1%) and significantly higher cardiac mortality (adjusted HR 2.40).
Conclusions:
- Despite angiographically successful PCI, a significant proportion of patients exhibit a suboptimal post-procedural dPR (≤ 0.89).
- A post-PCI dPR ≤ 0.89 is associated with an increased risk of target vessel failure and significantly higher cardiac mortality.
- These findings highlight the importance of physiological assessment post-PCI to identify patients at higher risk.
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.
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