Changes in post-PCI physiology based on anatomical vessel location: a DEFINE PCI substudy
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Authors
Matsumura, M.
Maehara, A.
Davis, J. E.
Kumar, G.
Sharp, A.
Samady, H.
Seto, A. H.
Cohen, D.
Patel, M. R.
Ali, Z. A.
Issue Date
2023-11-30
Type
Journal Article
Language
eng
Keywords
Alternative Title
BACKGROUND: Anatomical vessel location affects post-percutaneous coronary intervention (PCI) physiology. AIMS: We aimed to compare the post-PCI instantaneous wave-free ratio (iFR) in left anterior descending (LAD) versus non-LAD vessels and to identify the factors associated with a suboptimal post-PCI iFR. METHODS: DEFINE PCI was a multicentre, prospective, observational study in which a blinded post-PCI iFR pullback was used to assess residual ischaemia following angiographically successful PCI. RESULTS: Pre- and post-PCI iFR recordings of 311 LAD and 195 non-LAD vessels were compared. Though pre-PCI iFR in the LAD vessels (median 0.82 [0.63, 0.86]) were higher compared with those in non-LAD vessels (median 0.72 [0.49, 0.84]; p<0.0001), post-PCI iFR were lower in the LAD vessels (median 0.92 [0.88, 0.94] vs 0.98 [0.95, 1.00]; p<0.0001). The prevalence of a suboptimal post-PCI iFR of <0.95 was higher in the LAD vessels (77.8% vs 22.6%; p<0.0001). While the overall frequency of residual physiological diffuse disease (31.4% vs 38.6%; p=0.26) and residual focal disease in the non-stented segment (49.6% vs 50.0%; p=0.99) were similar in both groups, residual focal disease within the stented segment was more common in LAD versus non-LAD vessels (53.7% vs 27.3%; p=0.0009). Improvement in iFR from pre- to post-PCI was associated with angina relief regardless of vessel location. CONCLUSIONS: After angiographically successful PCI, post-PCI iFR is lower in the LAD compared with non-LAD vessels, resulting in a higher prevalence of suboptimal post-PCI iFR in LAD vessels. This difference is, in part, due to a greater frequency of a residual focal pressure gradient within the stented segment which may be amenable to more aggressive PCI.
Description
Citation
Matsumura M, Maehara A, Davis JE, Kumar G, Sharp A, Samady H, et al. Changes in post-PCI physiology based on anatomical vessel location: a DEFINE PCI substudy. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2023.
Publisher
EuroPCR
License
© The Author(s) 2023.
Journal
EuroIntervention