Changes in post-PCI physiology based on anatomical vessel location: a DEFINE PCI substudy

Area of Science:

• Cardiology
• Interventional Cardiology
• Physiology

Background:

• Anatomical location of coronary vessels influences physiological outcomes after percutaneous coronary intervention (PCI).
• Understanding these differences is crucial for optimizing PCI strategies and patient care.

Purpose of the Study:

• To compare post-PCI instantaneous wave-free ratio (iFR) between left anterior descending (LAD) and non-LAD vessels.
• To identify factors associated with suboptimal post-PCI iFR, particularly in LAD vessels.

Main Methods:

• A multicentre, prospective, observational study (DEFINE PCI) was conducted.
• Blinded post-PCI iFR pullback measurements were used to assess residual ischemia.
• 311 LAD and 195 non-LAD vessels were analyzed.

Main Results:

• Post-PCI iFR was lower in LAD vessels (median 0.92) compared to non-LAD vessels (median 0.98).
• The prevalence of suboptimal post-PCI iFR (<0.95) was significantly higher in LAD vessels (77.8%) versus non-LAD vessels (22.6%).
• Residual focal disease within the stented segment was more frequent in LAD vessels (53.7%) than in non-LAD vessels (27.3%).

Conclusions:

• Angiographically successful PCI results in lower post-PCI iFR in LAD vessels compared to non-LAD vessels.
• This difference is partly attributed to increased residual focal pressure gradients within stented segments of LAD vessels.
• These findings suggest potential for more aggressive PCI strategies in LAD lesions.