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Clinical Relevance of Impaired Physiological Assessment After Percutaneous Coronary Intervention: A Meta-analysis
Alexander M Griffioen1, Stijn C H van den Oord1,2, Steven Teerenstra3
1Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
Insights
Impaired physiological assessment after percutaneous coronary intervention (PCI) is linked to higher risks of major adverse cardiac events. Optimizing PCI based on physiology may improve patient outcomes, warranting further investigation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) aims for optimal angiographic results, but residual disease can cause major adverse cardiac events (MACE).
- Post-PCI physiological assessment is crucial for identifying residual stenosis that may impact long-term outcomes.
Purpose of the Study:
- To meta-analyze studies evaluating the relationship between post-PCI physiological assessment and long-term clinical outcomes.
- To determine if impaired physiological assessment after PCI predicts adverse cardiac events.
Main Methods:
- Systematic literature search conducted up to July 1, 2022.
- Meta-analysis of studies reporting on major adverse cardiac events, vessel-oriented cardiac events, or target vessel failure post-PCI.
- Inclusion of data on fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and quantitative flow ratio (QFR).
Main Results:
- Low post-PCI FFR (cutoff 0.84-0.90) in 4017 patients was associated with increased MACE (HR 2.06).
- Impaired post-PCI iFR (cutoff 0.95) showed a significant association with MACE (HR 3.38, P=0.04).
- Low post-PCI QFR (cutoff 0.89-0.91) in 1181 patients increased vessel-oriented cardiac events (HR 3.01).
- Overall impaired physiological assessment predicted increased MACE (HR 2.32), death (HR 1.41), myocardial infarction (HR 2.70), and target vessel revascularization (HR 2.88).
Conclusions:
- Impaired post-PCI physiological assessment is a significant predictor of adverse cardiac events, including death, MI, and TVR.
- Further prospective studies are needed to confirm if physiology-guided PCI optimization improves clinical outcomes.
Background:
Despite the optimal angiographic result of percutaneous coronary intervention (PCI), residual disease at the site of the culprit lesion can lead to major adverse cardiac events. Post-PCI physiological assessment can identify residual stenosis. This meta-analysis aims to investigate data of studies examining post-PCI physiological assessment in relation to long-term outcomes.
Methods:
Studies were included in the meta-analysis after performing a systematic literature search on July 1, 2022. The primary end point was the incidence of major adverse cardiac events, vessel-orientated cardiac events, or target vessel failure.
Results:
Low post-PCI fractional flow reserve, reported in 7 studies with fractional flow reserve cutoff values between 0.84 and 0.90, including 4017 patients, was associated with an increased rate of the primary end point (hazard ratio [HR], 2.06; 95% CI, 1.37-3.08). One study reported about impaired post-PCI instantaneous wave-free ratio with instantaneous wave-free ratio cutoff value of 0.95 in relation to major adverse cardiac events, showing a significant association (HR, 3.38; 95% CI, 0.99-11.6; P = .04). Low post-PCI quantitative flow ratio, reported in 3 studies with quantitative flow ratio cutoff value between 0.89 and 0.91, including 1181 patients, was associated with an increased rate of vessel-orientated cardiac events (HR, 3.01; 95% CI, 2.10-4.32). Combining data of all modalities, impaired physiological assessment showed an increased rate of the primary end point (HR, 2.32; 95% CI, 1.71-3.16) and secondary end points, including death (HR, 1.41; 95% CI, 1.04-1.89), myocardial infarction (HR, 2.70; 95% CI, 1.34-5.42) and target vessel revascularization (HR, 2.88; 95% CI, 1.91-4.35).
Conclusions:
Impaired post-PCI physiological assessment is associated with increased adverse cardiac events and individual end points, including death, myocardial infarction, and target vessel revascularization. Therefore, prospective studies are awaited on whether physiology-based optimization of PCI results in better clinical outcomes.
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