Physiological Distribution and Local Severity of Coronary Artery Disease and Outcomes After Percutaneous Coronary Intervention

Shin, Doosup; Dai, Neng; Lee, Seung Hun; Choi, Ki Hong; Lefieux, Adrien; Molony, David; Hwang, Doyeon; Kim, Hyun Kuk; Jeon, Ki‐Hyun; Lee, Hyun Jong; Jang, Ho-Jun; Ha, Sang Jin; Park, Taek Kyu; Yang, Jeong Hoon; Song, Young Bin; Hahn, Joo Yong; Choi, Seung Hyuk; Doh, Joon Hyung; Shin, Eun Seok; Nam, Chang Wook; Koo, Bon Kwon; Gwon, Hyeon Cheol; Ge, Junbo; Lee, Joo Myung

doi:10.1016/j.jcin.2021.06.013

Cited by 37 publications

(29 citation statements)

References 20 publications

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“…Previous studies have demonstrated that post‐PCI physiological results depend on pre‐PCI pressure drop patterns. 15 , 21 Vessels with focal disease patterns are more likely to achieve ischemia resolution by implanting stents, whereas those with diffuse disease would require more and longer stents, which is related with decreased procedural success and increased periprocedural complications, and thus worse longer term complications may be anticipated. Besides, given that vessels with diffuse disease may not be good candidates for PCI, post‐PCI physiological assessment, although it has prognostic value for the detection of residual disease burden, is too late for the decision of intervention strategy.…”

Section: Discussionmentioning

confidence: 99%

“…We used 0.78 as the cutoff, which is derived from our previous report. 15 Further studies with a larger sample size, clinical outcomes, and imaging data are required to validate the most reasonable cutoff value for the QFR‐PPG index. Third, the current cohort has a high post‐PCI QFR, with relatively low overall adverse events, which may represent low‐risk patients included; prospective studies with high‐risk patients and complex lesions will be helpful to confirm our findings.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Implications of Prestent Pullback Pressure Gradient and Poststent Quantitative Flow Ratio in Patients Undergoing Percutaneous Coronary Intervention

Yuan

Dou

Zhang

et al. 2022

JAHA

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Background Coronary diffuse disease associates with poor outcomes, but little is known about its role after percutaneous coronary intervention (PCI). We aimed to investigate the prognostic implication of pre‐PCI focal or diffuse disease patterns combined with post‐PCI quantitative flow ratio (QFR). Methods and Results Pre‐PCI QFR derived pullback pressure gradient (PPG) (QFR‐PPG) was measured to assess physiological disease patterns for 1685 included vessels; the vessels were classified according to dichotomous pre‐PCI QFR‐PPG and post‐PCI QFR. Vessel‐oriented composite outcome, a composite of vessel‐related ischemia‐driven revascularization, vessel‐related myocardial infarction, or cardiac death at 2 years was compared among these groups. Vessels with low pre‐PCI PPG (3.9% versus 2.0%, hazard ratio [HR], 1.93; 95% CI, 1.08–3.44; P =0.02) or low post‐PCI QFR (9.8% versus 2.7%, HR, 3.78; 95% CI, 1.61–8.87; P =0.001) demonstrated higher vessel‐oriented composite outcome risk after stent implantation. Of note, despite high post‐PCI QFR achieved, vessels with low pre‐PCI QFR‐PPG presented higher risk of vessel‐oriented composite outcome than those with high pre‐PCI QFR‐PPG (3.7% versus 1.8%, HR, 2.03; 95% CI, 1.09–3.76; P =0.03) and pre‐PCI QFR‐PPG demonstrated direct prognostic effect not mediated by post‐PCI QFR. Integration of groups classified by pre‐PCI QFR‐PPG and post‐PCI QFR showed significantly higher discriminant and reclassification abilities than clinical factors (C‐index 0.77 versus 0.72, P =0.03; integrated discrimination improvement 0.93%, P =0.04; net reclassification index 0.33, P =0.02). Conclusions Prognostic value of pre‐PCI focal or diffuse disease patterns assessed by QFR‐PPG index was retained even after successful PCI, which is mostly explained by its direct effect that was not mediated by post‐PCI QFR. Integration of both pre‐PCI and post‐PCI physiological information can provide better risk stratification in vessels with stent implantation. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05104580.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic Implications of Prestent Pullback Pressure Gradient and Poststent Quantitative Flow Ratio in Patients Undergoing Percutaneous Coronary Intervention

Yuan

Dou

Zhang

et al. 2022

JAHA

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“…Recently studies by Biscaglia et al and Shin et al have suggested that functional patterns of coronary artery disease categorized as focal, serial, or diffuse based on pre-PCI QFR analyses can predict post-PCI QFR [ 72 , 73 ]. Using pre-PCI virtual pull backs of QFR, physiological distribution was determined in patients who underwent angiographically successful PCI and post-PCI FFR measurement by pull back pressure gradient index to define predominant focal versus diffuse disease.…”

Section: Concept Of ‘Virtual Stenting’ and Residual Angiography-based...mentioning

confidence: 99%

“…Using pre-PCI virtual pull backs of QFR, physiological distribution was determined in patients who underwent angiographically successful PCI and post-PCI FFR measurement by pull back pressure gradient index to define predominant focal versus diffuse disease. Interestingly, cumulative incidence of TVF after PCI was significantly higher in patients with predominant diffuse disease [ 73 ].…”

Section: Concept Of ‘Virtual Stenting’ and Residual Angiography-based...mentioning

confidence: 99%

Angiography-Based Fractional Flow Reserve: State of the Art

et al. 2022

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Purpose of Review Three-dimensional quantitative coronary angiography-based methods of fractional flow reserve (FFR) derivation have emerged as an appealing alternative to conventional pressure-wire-based physiological lesion assessment and have the potential to further extend the use of physiology in general. Here, we summarize the current evidence related to angiography-based FFR and perspectives on future developments. Recent Findings Growing evidence suggests good diagnostic performance of angiography-based FFR measurements, both in chronic and acute coronary syndromes, as well as in specific lesion subsets, such as long and calcified lesions, left main coronary stenosis, and bifurcations. More recently, promising results on the superiority of angiography-based FFR as compared to angiography-guided PCI have been published. Summary Currently available angiography -FFR indices proved to be an excellent alternative to invasive pressure wire-based FFR. Dedicated prospective outcome data comparing these indices to routine guideline recommended PCI including the use of FFR are eagerly awaited.

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“…[19][20][21] Pullback curves from QFR diagrams were extracted and digitalized using the OriginPro, Data are presented as mean ± SD or n (%). ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BMI, body mass index; CABG, coronary artery bypass graft; DM, diabetes mellitus; EF, left ventricular eject fraction; HbA1c, glycated hemoglobin A1c; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; PCI, percutaneous coronary intervention; TG, triglyceride.…”

mentioning

confidence: 99%

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions　― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―

Geng

Shi

Yuan

et al. 2023

Circ J

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Background: Data regarding the performance of computational fractional flow reserve in patients with diabetes mellitus (DM) remain scarce. This study sought to explore the impact of DM on quantitative flow ratio (QFR) and its association with intravascular ultrasound (IVUS)-derived anatomical references.Methods and Results: IVUS and QFR were retrospectively analyzed in 237 non-diabetic and 93 diabetic patients with 250 and 102 intermediate lesions, respectively. Diabetics were further categorized based on adequate (HbA1c <7.0%: 47 patients with 53 lesions) or poor (HbA1c ≥7.0%: 46 patients with 49 lesions) glycemic control. Lesions with QFR ≤0.8 or minimum lumen area (MLA) ≤4.0 mm 2 and plaque burden (PB, %) ≥70 were considered functionally or anatomically significant, respectively. PB increased, and MLA decreased stepwise across non-diabetics, diabetics with adequate glycemic control and those with poor glycemic control. In contrast, QFR was similar among the 3 groups. PB correlated significantly with the QFR for lesions in non-diabetics, but not for lesions in diabetics. DM was independently correlated with the functionally non-significant lesions (QFR >0.8) with high-risk IVUS features (MLA ≤4.0 mm 2 and PB ≥70; OR 2.053, 95% CI: 1.137-3.707, P=0.017). When considering the effect of glycemic control, HbA1c was an independent predictor of anatomical-functional discordance (OR 1.347, 95% CI: 1.089-1.667, P=0.006).Conclusions: Anatomical-functional discordance of intermediate coronary lesions assessed by IVUS and QFR is exacerbated in patients with diabetes, especially when glycemia is poorly controlled.

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Physiological Distribution and Local Severity of Coronary Artery Disease and Outcomes After Percutaneous Coronary Intervention

Cited by 37 publications

References 20 publications

Prognostic Implications of Prestent Pullback Pressure Gradient and Poststent Quantitative Flow Ratio in Patients Undergoing Percutaneous Coronary Intervention

Prognostic Implications of Prestent Pullback Pressure Gradient and Poststent Quantitative Flow Ratio in Patients Undergoing Percutaneous Coronary Intervention

Angiography-Based Fractional Flow Reserve: State of the Art

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions　― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―

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Physiological Distribution and Local Severity of Coronary Artery Disease and Outcomes After Percutaneous Coronary Intervention

Cited by 37 publications

References 20 publications

Prognostic Implications of Prestent Pullback Pressure Gradient and Poststent Quantitative Flow Ratio in Patients Undergoing Percutaneous Coronary Intervention

Prognostic Implications of Prestent Pullback Pressure Gradient and Poststent Quantitative Flow Ratio in Patients Undergoing Percutaneous Coronary Intervention

Angiography-Based Fractional Flow Reserve: State of the Art

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions ― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―

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Product

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Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions　― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―