Validation of Segmental Post-PCI Physiological Gradients With IVUS-Detected Focal Lesions and Stent Underexpansion
Authors' conclusion
In patients with post-PCI FFR <0.90, segmental post-PCI pressure gradients have moderate discriminative ability to identify IVUS-detected focal lesions but no discriminative ability to identify IVUS-detected stent underexpansion.
Study context
- Population
- Patients with angiographically successful postpercutaneous coronary intervention (PCI) and post-PCI fractional flow reserve (FFR) <0.90 with complete intravascular ultrasound (IVUS) and FFR pullback data
- Participants
- 139 vessels
- Comparison
- Segmental post-PCI FFR, Pd/Pa and diastolic pressure ratio (dPR) gradients vs IVUS-detected residual disease
- Outcome
- Diagnostic performance of segmental gradients to detect IVUS-detected residual focal lesions and stent underexpansion
Methodological detailssecondary analysis of the FFR REACT trial (IVUS-guided optimization arm), dPR calculated offline using dedicated software, Segments ≥5 mm evaluated
- Secondary analysis of the FFR REACT trial (IVUS-guided optimization arm)
- dPR calculated offline using dedicated software
- Segments ≥5 mm evaluated
Performance
As reported in the abstract
Discrimination of IVUS-detected distal/proximal focal lesions and stent underexpansion
| Test or model | AUC distal lesions | AUC proximal lesions | AUC stent underexpansion (in-stent) | AUC focal lesions (range, with dPR) | AUC focal lesions (range, with Pd/Pa) |
|---|---|---|---|---|---|
| FFR | 0.69 | 0.84 | 0.52 | — not stated in the abstract | — not stated in the abstract |
| Pd/Pa | — not stated in the abstract | — not stated in the abstract | 0.54 | 0.58 to 0.69 | — not stated in the abstract |
| dPR | — not stated in the abstract | — not stated in the abstract | 0.55 | — not stated in the abstract | 0.58 to 0.69 |
AUC distal lesions
FFR0.69
Pd/Pa— not stated in the abstract
dPR— not stated in the abstract
AUC proximal lesions
FFR0.84
Pd/Pa— not stated in the abstract
dPR— not stated in the abstract
AUC stent underexpansion (in-stent)
FFR0.52
Pd/Pa0.54
dPR0.55
AUC focal lesions (range, with dPR)
FFR— not stated in the abstract
Pd/Pa0.58 to 0.69
dPR— not stated in the abstract
AUC focal lesions (range, with Pd/Pa)
FFR— not stated in the abstract
Pd/Pa— not stated in the abstract
dPR0.58 to 0.69
— not stated in the abstract
Further findings
Prevalence of IVUS-detected residual disease
- Focal distal lesions
- 23 (17.4%) of 132
- Focal proximal lesions
- 14 (12.6%) of 111
- Stent underexpansion
- 86 (61.9%)
- Mean post-PCI FFR
- 0.83 ± 0.05, range 0.56-0.89
Original publication
Validation of Segmental Post-PCI Physiological Gradients With IVUS-Detected Focal Lesions and Stent Underexpansion. JACC Cardiovasc Interv. Published 21 June 2023. doi:10.
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