Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Dec 18;19(11):e903-e912.
doi: 10.4244/EIJ-D-23-00517.

Changes in post-PCI physiology based on anatomical vessel location: a DEFINE PCI substudy

Mitsuaki Matsumura  1 , Akiko Maehara  1   2 , Justin E Davis  3 , Gautam Kumar  4 , Andrew Sharp  5 , Habib Samady  4 , Arnold H Seto  6 , David Cohen  1   7 , Manesh R Patel  8 , Ziad A Ali  1   7 , Gregg W Stone  9 , Allen Jeremias  1   7
Affiliations
Observational Study

Changes in post-PCI physiology based on anatomical vessel location: a DEFINE PCI substudy

Mitsuaki Matsumura et al. EuroIntervention. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

M. Matsumura is a consultant for Terumo and Boston Scientific. A. Maehara is a consultant for Boston Scientific; receives honoraria from Nipro and Boston Scientific; and is on the advisory board of SpectraWave. J. Davies has patents pertaining to the iFR technology; and is a consultant for Philips. A. Sharp is a consultant for Philips, Medtronic, Boston Scientific, ReCor Medical, and Penumbra; and receives honoraria from Medtronic, Boston Scientific, Philips, Recor Medical, and Penumbra. H. Samady is on the advisory board of Philips; co-founder and equity holder in Covanos; and a holder of four patents in the computational physiology space. A. Seto receives research grants from Philips; and is part of the leadership of SCAI. D. Cohen receives institutional grant support from Philips; is a consultant for Abbott, Edwards Lifesciences, and HeartBeam; and is on the advisory board of Medtronic. M. Patel receives research grants from Philips; and is a consultant for Bayer, Janssen, and Novartis. Z.A. Ali receives institutional grant support from Abbott, Abiomed, Acist, Amgen, Boston Scientific, Cathworks, Canon, Conavi, HeartFlow, Inari, Medtronic Inc, National Institute of Health, Nipro, Opsens Medical, Medis, Philips, Shockwave Medical, Siemens, Spectrawave, and Teleflex; is a consultant for Abiomed, AstraZeneca, Boston Scientific, Cathworks, OpSens, Philips, and Shockwave Medical; receives a honoraria from Abiomed, AstraZeneca, Boston Scientific, Cathworks, OpSens, Philips, and Shockwave Medical; and has equity/options from Elucid, Lifelink, SpectraWave, Shockwave Medical, and VitalConnect. G.W. Stone has received institutional grant support from Abbott, Abiomed, Bioventrix, Cardiovascular Systems Inc, Philips, Biosense-Webster, Shockwave Medical, Vascular Dynamics, Pulnovo, and V-Wave; is a consultant for Abbott, Daiichi Sankyo, Ablative Solutions, CorFlow, Cardiomech, Robocath, Miracor, Vectorious, Apollo Therapeutics, Valfix, TherOx, HeartFlow, Neovasc, Ancora, Elucid Bio, Occlutech, Impulse Dynamics, Adona Medical, Millennia Biopharma, Oxitope, Cardiac Success, and HighLife; received honoraria from Medtronic, Pulnovo, Infraredx, Abiomed, Amgen, and Boehringer Ingelheim; and has equity/options from Ancora, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, Valfix, and Xenter. A. Jeremias receives institutional grant support from Philips; is a consultant for Philips, Abbott Vascular, ACIST Medical, Shockwave Medical, and Cathworks; and is on the advisory board of Philips. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Comparison of individual pre- and post-PCI iFR in LAD versus non-LAD vessels.
Median (first quartile, third quartile) pre-PCI and post-PCI iFR were 0.82 (0.63, 0.86) and 0.92 (0.88, 0.94) in LAD vessels and 0.72 (0.49, 0.84) and 0.98 (0.95, 1.00) in non-LAD vessels, respectively. Pre- to post-PCI iFR gain was less in LAD versus non-LAD vessels. iFR: instantaneous wave-free ratio; LAD: left anterior descending artery; PCI: percutaneous coronary intervention
Figure 2
Figure 2. Distribution of iFR gain in LAD versus non-LAD vessels.
iFR gain (defined as post-PCI iFR minus pre-PCI iFR) was significantly less in LAD vessels compared with non-LAD vessels. iFR: instantaneous wave-free ratio; LAD: left anterior descending artery; PCI: percutaneous coronary intervention; Q: quartile
Figure 3
Figure 3. One-year target vessel failure between LAD versus non-LAD vessels.
Patient-level Kaplan-Meier curves for target vessel failure. There was no significant difference in clinical events at 1 year between LAD versus non-LAD target vessels. CI: confidence interval; HR: hazard ratio; LAD: left anterior descending artery
Central illustration
Central illustration. Comparison of physiological assessment in the LAD versus non-LAD vessels.
iFR: instantaneous wave-free ratio; LAD: left anterior descending; PCI: percutaneous coronary intervention
See this image and copyright information in PMC

References

    1. Davies JE, Sen S, Dehbi HM, Al-Lamee R, Petraco R, Nijjer SS, Bhindi R, Lehman SJ, Walters D, Sapontis J, Janssens L, Vrints CJ, Khashaba A, Laine M, Van Belle, Krackhardt F, Bojara W, Going O, Härle T, Indolfi C, Niccoli G, Ribichini F, Tanaka N, Yokoi H, Takashima H, Kikuta Y, Erglis A, Vinhas H, Canas Silva, Baptista SB, Alghamdi A, Hellig F, Koo BK, Nam CW, Shin ES, Doh JH, Brugaletta S, Alegria-Barrero E, Meuwissen M, Piek JJ, van Royen, Sezer M, Di Mario, Gerber RT, Malik IS, Sharp ASP, Talwar S, Tang K, Samady H, Altman J, Seto AH, Singh J, Jeremias A, Matsuo H, Kharbanda RK, Patel MR, Serruys P, Escaned J. Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. N Engl J Med. 2017;376:1824–34. - PubMed
    1. Götberg M, Christiansen EH, Gudmundsdottir IJ, Sandhall L, Danielewicz M, Jakobsen L, Olsson SE, Ohagen P, Olsson H, Omerovic E, Calais F, Lindroos P, Maeng M, Tödt T, Venetsanos D, James SK, Kåregren A, Nilsson M, Carlsson J, Hauer D, Jensen J, Karlsson AC, Panayi G, Erlinge D, Fröbert O iFR-SWEDEHEART Investigators. Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI. N Engl J Med. 2017;376:1813–23. - PubMed
    1. Hwang D, Jeon KH, Lee JM, Park J, Kim CH, Tong Y, Zhang J, Bang JI, Suh M, Paeng JC, Na SH, Cheon GJ, Cook CM, Davies JE, Koo BK. Diagnostic Performance of Resting and Hyperemic Invasive Physiological Indices to Define Myocardial Ischemia: Validation With 13N-Ammonia Positron Emission Tomography. JACC Cardiovasc Interv. 2017;10:751–60. - PubMed
    1. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention. 2019;14:1435–534. - PubMed
    1. Agarwal SK, Kasula S, Hacioglu Y, Ahmed Z, Uretsky BF, Hakeem A. Utilizing Post-Intervention Fractional Flow Reserve to Optimize Acute Results and the Relationship to Long-Term Outcomes. JACC Cardiovasc Interv. 2016;9:1022–31. - PubMed

Publication types