Related Experiment Video
Updated: Jul 11, 2025
Author Spotlight: Improved Localization and Monitoring of Coronary Flow Reserve Using Modified PLAX View in Mice
Published on: August 25, 2023
Preprocedural physiological assessment of coronary disease patterns to predict haemodynamic outcomes post-PCI
Nozomi Kotoku1, Kai Ninomiya1, Shinichiro Masuda1
1Department of Cardiology, University of Galway, Galway, Ireland.
Insights
Pre-procedural assessment of diffuse coronary artery disease (CAD) using quantitative flow ratio (μQFR) and pullback pressure gradient (PPG) can predict suboptimal outcomes after percutaneous coronary intervention (PCI), even with intracoronary imaging guidance.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Suboptimal hemodynamic outcomes after percutaneous coronary intervention (PCI) can persist despite intracoronary imaging-guided stent optimization, often due to residual lesions in non-stented segments.
- Preprocedural assessment of coronary artery disease (CAD) patterns may predict physiological responses to PCI.
Purpose of the Study:
- To evaluate the association between preprocedural hemodynamic patterns and intracoronary imaging findings.
- To determine the relationship between these patterns and immediate physiological outcomes post-PCI.
Main Methods:
- Analysis of data from 206 patients with chronic coronary syndrome in the ASET-JAPAN study.
- Characterization of pathophysiological CAD patterns using quantitative flow ratio (μQFR)-derived indices and pullback pressure gradient (PPG) index from pre-PCI angiograms.
- Assessment of intracoronary imaging in stented segments post-stent optimization.
Main Results:
- Diffuse disease, defined by pre-PCI μQFR-PPG index, independently predicted suboptimal post-PCI μQFR (<0.91).
- Stent expansion index (EI) was not associated with suboptimal post-PCI μQFR.
- Vessels with suboptimal post-PCI μQFR and adequate EI predominantly showed diffuse CAD patterns pre-PCI.
- Higher plaque burden in stented segments was observed in vessels with preprocedural diffuse CAD.
Conclusions:
- A preprocedural physiological diffuse CAD pattern is an independent predictor of unfavorable immediate hemodynamic outcomes post-PCI.
- Preprocedural CAD pattern assessment can identify patients likely to achieve superior immediate hemodynamic outcomes after PCI.
Background:
Even with intracoronary imaging-guided stent optimisation, suboptimal haemodynamic outcomes post-percutaneous coronary intervention (PCI) can be related to residual lesions in non-stented segments. Preprocedural assessment of pathophysiological coronary artery disease (CAD) patterns could help predict the physiological response to PCI.
Aims:
The aim of this study was to assess the relationship between preprocedural pathophysiological haemodynamic patterns and intracoronary imaging findings, as well as their association with physiological outcomes immediately post-PCI.
Methods:
Data from 206 patients with chronic coronary syndrome enrolled in the ASET-JAPAN study were analysed. Pathophysiological CAD patterns were characterised using Murray law-based quantitative flow ratio (μQFR)-derived indices acquired from pre-PCI angiograms. The diffuseness of CAD was defined by the pullback pressure gradient (PPG) index. Intracoronary imaging in stented segments after stent optimisation was also analysed.
Results:
In the multivariable analysis, diffuse disease - defined by the pre-PCI μQFR-PPG index - was an independent factor for predicting a post-PCI μQFR <0.91 (per 0.1 decrease of PPG index, odds ratio 1.57, 95% confidence interval: 1.07-2.34; p=0.022), whereas the stent expansion index (EI) was not associated with a suboptimal post-PCI μQFR. Among vessels with an EI ≥80% and post-PCI μQFR <0.91, 84.0% of those vessels had a diffuse pattern preprocedure. There was no significant difference in EI between vessels with diffuse disease and those with focal disease. The average plaque burden in the stented segment was significantly larger in vessels with a preprocedural diffuse CAD pattern.
Conclusions:
A physiological diffuse pattern preprocedure was an independent factor in predicting unfavourable immediate haemodynamic outcomes post-PCI, even after stent optimisation using intracoronary imaging. Preprocedural assessment of CAD patterns could identify patients who are likely to exhibit superior immediate haemodynamic outcomes following PCI.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:21Cardiac Catheterization II: Right Heart Catheterization
01:28Imaging Studies for Cardiovascular System V: CT