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Impact of coronary artery disease patterns assessed with pullback pressure gradient on clinical outcomes:
Adrian Bednarek1, Patrick W Serruys2, Tsung-Ying Tsai2
1First Department of Cardiology, Medical University of Warsaw, Poland.
Insights
Pullback pressure gradient (PPG) helps define coronary artery disease (CAD) patterns. Diffuse CAD, identified by PPG, is linked to poorer physiological results after percutaneous coronary intervention (PCI) and increased cardiovascular event risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Diffuse coronary artery disease (CAD) lacks a standardized definition, impacting patient outcomes.
- Pullback pressure gradient (PPG) is a novel index for quantifying CAD patterns, but its prognostic value needs further elucidation.
Purpose of the Study:
- To comprehensively assess the prognostic impact of PPG in defining CAD patterns.
- To evaluate the association between PPG-defined CAD patterns and clinical and physiological outcomes post-percutaneous coronary intervention (PCI).
Main Methods:
- A systematic literature search was conducted across EMBASE, Medline, and PubMed databases following PRISMA guidelines.
- Included studies reported pre-PCI PPG measurements and post-PCI physiological indices or clinical outcomes.
- The primary endpoint was a composite of major adverse cardiovascular events (MACE) or target vessel failure (TVF).
Main Results:
- Thirteen studies were included, utilizing both invasive and angio-based PPG methods.
- A moderate correlation was found between PPG and post-PCI fractional flow reserve (FFR) (r=0.44).
- Diffuse CAD lesions were associated with lower post-PCI FFR, more frequent suboptimal physiological results, and significantly increased risk of MACE, TVF, myocardial infarction, and target vessel revascularization.
Conclusions:
- The pattern of CAD, as assessed by PPG, significantly influences post-PCI physiological results.
- PPG-defined CAD patterns are a significant predictor of adverse cardiovascular events.
Background And Aims:
Diffuse coronary artery disease (CAD) impacts patients' outcomes; however, its definition is not objectively established and varies across studies. Pullback pressure gradient (PPG) is a novel physiological index for quantitatively evaluating the pattern of CAD; nevertheless, its clinical utility has not been fully elucidated. This study aims to comprehensively assess the PPG prognostic impact on clinical and physiological outcomes.
Methods:
The EMBASE, Medline, and PubMed databases were searched, following the PRISMA guidelines. Studies reporting pre-percutaneous coronary intervention (PCI) PPG measurements and post-PCI physiological indices or clinical outcomes were included. Data on clinical events were extracted at the longest reported follow-up. The primary endpoint for this meta-analysis was the composite of clinical events (major adverse cardiovascular events [MACE] or target vessel failure [TVF]).
Results:
Thirteen studies were included in the analyses. In five studies, pullbacks were performed using an invasive approach, whilst eight used an angio-based method. The correlation between PPG and post-PCI fractional flow reserve (FFR) values was moderate (r =0.44, 95%CI:0.34-0.52, p < 0.001). Compared to focal lesions, diffuse lesions had significantly lower post-PCI FFRs (mean difference = -0.05, -0.07 to -0.04, p < 0.001) and significantly more frequent (RR = 1.93, 95%CI:1.76-2.11, p < 0.001) suboptimal post-PCI physiological results (defined as low post-PCI FFR). Diffuse lesions were significantly associated with the composite of clinical events (RR = 1.71, 1.34-2.20, p < 0.001), MACE, TVF, myocardial infarction, and target vessel revascularization.
Conclusions:
The pattern of coronary artery disease, as defined using PPG, significantly impacts physiological results post-PCI and the risk of cardiovascular events.
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