Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes
Authors' conclusion
Pathophysiologic coronary artery disease patterns distinctly affect the safety and effectiveness of PCI. PPG showed an excellent predictive capacity for optimal revascularization and demonstrated added value compared with an FFR measurement.
Study context
- Population
- Patients with ≥1 epicardial lesion with fractional flow reserve (FFR) ≤0.80 scheduled for percutaneous coronary intervention (PCI)
- Participants
- 993 patients1,044 vessels
- Exposure
- Pullback pressure gradient (PPG) vs FFR alone for predicting optimal revascularization
- Outcome
- Optimal revascularization (FFR ≥0.88 after PCI)
Methodological detailsinvestigator-initiated, single-arm, multicentre
- Investigator-initiated
- Single-arm
- Multicentre
Main finding
As reported in the abstract
Prediction of optimal revascularization
| Group | AUC |
|---|---|
| PPG | 0.82 [95% CI, 0.79-0.84]; P<0.001 |
| FFR | 0.54 [95% CI, 0.50-0.57] |
AUC
PPG0.82 [95% CI, 0.79-0.84]; P<0.001
FFR0.54 [95% CI, 0.50-0.57]
Observational data: associations, not effects.
Further findings
Correlation of PPG with change in FFR after PCI
- R
- 0.65 [95% CI, 0.61-0.69]; P<0.001
Baseline and post-PCI physiology
- Mean FFR
- 0.68±0.12
- PPG
- 0.62±0.17
- Post-PCI FFR
- 0.87±0.07
Treatment decisions changed by PPG
- Redirected from PCI to alternative treatment
- 14%
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Periprocedural MILow PPG (<0.62)vs Focal disease | 1.71 (1.00–2.97) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes. Circulation. Published 14 May 2024. doi:10.
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