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Change in Pd/Pa: Clinical Implications for Predicting Future Cardiac Events at Deferred Coronary Lesions
Kota Murai1, Yu Kataoka1, Eri Kiyoshige2
1Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Insights
A change in distal coronary artery pressure/aortic pressure (Pd/Pa) can help identify patients at higher cardiovascular risk, even with intermediate stenosis. This physiological measure may stratify risk for future cardiac events in lesions with fractional flow reserve (FFR) ≥0.81.
Area of Science:
- Cardiology
- Interventional Cardiology
- Physiology
Background:
- Cardiovascular events occur even with intermediate stenosis (FFR ≥0.81).
- A reduction in distal coronary artery pressure/aortic pressure (Pd/Pa) during hyperemia reflects lipid burden.
- This physiological change may stratify risk in deferrable lesions.
Purpose of the Study:
- To investigate the association between change in Pd/Pa and future cardiac events.
- To determine if change in Pd/Pa can stratify risk in lesions with FFR ≥0.81.
Main Methods:
- Lesion- and patient-based analyses of 899 intermediate lesions and deferred patients.
- Investigated the association between change in Pd/Pa and target lesion failure (TLF) and major adverse cardiac events over 7 years.
- Compared outcomes based on change in Pd/Pa thresholds (≥0.10) and FFR values.
Main Results:
- TLF and major adverse cardiac events occurred in 6.7% and 13.4% of patients, respectively.
- Lesions with TLF showed a greater change in Pd/Pa (0.11±0.03 vs. 0.09±0.04; P=0.002).
- Change in Pd/Pa ≥0.10 significantly predicted TLF (OR 2.94) and major adverse cardiac events (OR 1.85).
- Lesions with FFR ≤0.85 and change in Pd/Pa ≥0.10 had a substantially higher TLF likelihood (12.4% vs. 2.9%).
Conclusions:
- A change in Pd/Pa ≥0.10 indicates higher cardiovascular risk despite deferrable FFR values.
- Change in Pd/Pa can help stratify lesion- and patient-level risks in those with FFR ≥0.81.
- This physiological measure offers additional risk stratification beyond FFR alone.
Background:
Cardiovascular events still occur at intermediate stenosis with fractional flow reserve (FFR) ≥0.81, underscoring the additional measure to evaluate this residual risk. A reduction in distal coronary artery pressure/aortic pressure (Pd/Pa) from baseline to hyperemia (ie, change in Pd/Pa) reflects lipidic burden within vessel walls. We hypothesized that this physiological measure might stratify the risk of future cardiac events at deferrable lesions.
Methods:
Lesion- (899 intermediate lesions) and patient-based (899 deferred patients) analyses in those with FFR ≥0.81 were conducted to investigate the association between change in Pd/Pa and target lesion failure (TLF) and major adverse cardiac events at 7 years, respectively.
Results:
The occurrence of TLF and major adverse cardiac events was 6.7% and 13.4%, respectively. The incidence of target lesion-related nonfatal myocardial infarction was 0.6%. Lesions with TLF had a greater change in Pd/Pa (0.11±0.03 versus 0.09±0.04; P=0.002), larger diameter stenosis (51.0±9.2% versus 46.4±12.4%; P=0.048), and smaller FFR (0.84 [0.82-0.87] versus 0.86 [0.83-0.90]; P=0.02). Change in Pd/Pa (per 0.01 increase) predicted TLF (odds ratio, 1.16 [95% CI, 1.05-1.28]; P=0.002) and major adverse cardiac event (odds ratio, 1.08 [95% CI, 1.01-1.16]; P=0.03). Lesions with change in Pd/Pa ≥0.10 had 2.94- and 1.85-fold greater likelihood of TLF (95% CI, 1.30-6.69; P=0.01) and major adverse cardiac event (95% CI, 1.08-3.17; P=0.03), respectively. Lesions with FFR ≤0.85 had a substantially higher likelihood of TLF when there is a change in Pd/Pa ≥0.10 (12.4% versus 2.9%; hazard ratio, 3.60 [95% CI, 1.01-12.80]; P=0.04). However, change in Pd/Pa did not affect TLF risk in lesions with FFR ≥0.86 (3.8% versus 3.7%; hazard ratio, 0.56 [95% CI, 0.06-5.62]; P=0.62).
Conclusions:
Despite deferrable FFR values, lesions and patients with a change in Pd/Pa ≥0.10 had higher cardiovascular risk. Change in Pd/Pa might help stratify lesion- and patient-level risks of future cardiac events in those with FFR ≥0.81.
