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Angiography-derived physiological patterns of coronary artery disease: implications with post-stenting physiology and
Simone Fezzi1,2, Paolo Alberto Del Sole1, Francesco Burzotta3,4
1Division of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, Verona, Italy.
Insights
Physiological patterns of coronary artery disease (CAD) impact percutaneous coronary intervention (PCI) outcomes. Suboptimal post-PCI physiology, more common in diffuse CAD, increases vessel-oriented clinical outcomes (VOCE) risk, suggesting intravascular imaging may improve results.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) physiological patterns influence percutaneous coronary intervention (PCI) functional results and vessel-oriented clinical outcomes (VOCE).
- Understanding these patterns is crucial for optimizing PCI strategies and patient prognosis.
Purpose of the Study:
- To evaluate the impact of angiography-derived physiological patterns of CAD on post-PCI functional results.
- To assess the association between these patterns and long-term VOCE.
Main Methods:
- Quantitative interpretation of pre-PCI angiography-derived fractional flow reserve (FFR) virtual pullbacks to determine CAD physiological patterns.
- Definition of suboptimal post-PCI physiology as an angiography-derived FFR ≤ 0.91.
- Primary endpoint: VOCE occurrence at longest available follow-up.
Main Results:
- Diffuse CAD patterns were associated with lower post-PCI FFR values and a higher rate of suboptimal post-PCI physiology compared to focal patterns.
- Suboptimal post-PCI physiology significantly increased the risk of VOCE (HR: 2.311).
- Intracoronary imaging use in diffuse disease correlated with a lower incidence of long-term VOCE (5.1% vs. 14.8%).
Conclusions:
- Suboptimal post-PCI physiology is more frequent in diffuse CAD and linked to increased VOCE risk.
- Intravascular imaging may enhance clinical outcomes in patients with diffuse CAD.
Background:
Physiological patterns of coronary artery disease (CAD) have emerged as potential determinants of functional results of percutaneous coronary interventions (PCI) and of vessel-oriented clinical outcomes (VOCE).
Objectives:
In this study, we evaluated the impact of angiography-derived physiological patterns of CAD on post-PCI functional results and long-term clinical outcomes.
Methods:
Pre-PCI angiography-derived fractional flow reserve (FFR) virtual pullbacks were quantitatively interpreted and used to determine the physiological patterns of CAD. Suboptimal post-PCI physiology was defined as an angiography-derived FFR value ≤ 0.91. The primary endpoint was the occurrence of VOCE at the longest available follow-up.
Results:
Six hundred fifteen lesions from 516 patients were stratified into predominantly focal (n = 322, 52.3%) and predominantly diffuse (n = 293, 47.7%). Diffuse pattern of CAD was associated with lower post-PCI angiography-derived FFR values (0.91 ± 0.05 vs. 0.94 ± 0.05; p = 0.001) and larger rate of suboptimal post-PCI physiology (43.0 vs. 22.7%; p = 0.001), as compared to focal CAD. At the median follow-up time of 37 months (33-58), post-PCI suboptimal physiology was related to a higher risk of VOCE (16.2% vs. 7.6%; HR: 2.311; 95% CI 1.410-3.794; p = 0.0009), while no significant difference was noted according to baseline physiological pattern. In diffuse disease, the use of intracoronary imaging was associated with a lower incidence of long-term VOCE (5.1% vs 14.8%; HR: 0.313, 95% CI 0.167-0.614, p = 0.030).
Conclusions:
Suboptimal post-PCI physiology is observed more often in diffusely diseased arteries and it is associated with higher risk of VOCE at follow-up. The use of intravascular imaging might improve clinical outcomes in the setting of diffuse CAD.
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