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. 2024 Dec;113(12):1745-1756.
doi: 10.1007/s00392-024-02500-8. Epub 2024 Aug 5.

Angiography-derived physiological patterns of coronary artery disease: implications with post-stenting physiology and long-term clinical outcomes

Simone Fezzi  1   2 , Paolo Alberto Del Sole  1 , Francesco Burzotta  3   4 , Antonio Maria Leone  3   4 , Daixin Ding  2   5 , Dimitrios Terentes-Printzios  6 , Carlo Trani  3   4 , Luca Bonizzi  1 , Sara Sgreva  1 , Stefano Andreaggi  1 , Jiayue Huang  2   5 , Gabriele Pesarini  1 , Domenico Tavella  1 , Guy Prado  1   7 , Andrea Vicerè  3   4 , Dimitrios Oikonomou  6 , Konstantia Paraskevi Gkini  6 , Domenico Galante  3   4 , Konstantinos Tsioufis  6 , Charalambos Vlachopoulos  6 , William Wijns  2 , Flavio Ribichini  1 , Shengxian Tu  8 , Roberto Scarsini  9
Affiliations

Angiography-derived physiological patterns of coronary artery disease: implications with post-stenting physiology and long-term clinical outcomes

Simone Fezzi et al. Clin Res Cardiol. 2024 Dec.

Abstract

Background: Physiological patterns of coronary artery disease (CAD) have emerged as potential determinants of functional results of percutaneous coronary interventions (PCI) and of vessel-oriented clinical outcomes (VOCE).

Objectives: In this study, we evaluated the impact of angiography-derived physiological patterns of CAD on post-PCI functional results and long-term clinical outcomes.

Methods: Pre-PCI angiography-derived fractional flow reserve (FFR) virtual pullbacks were quantitatively interpreted and used to determine the physiological patterns of CAD. Suboptimal post-PCI physiology was defined as an angiography-derived FFR value ≤ 0.91. The primary endpoint was the occurrence of VOCE at the longest available follow-up.

Results: Six hundred fifteen lesions from 516 patients were stratified into predominantly focal (n = 322, 52.3%) and predominantly diffuse (n = 293, 47.7%). Diffuse pattern of CAD was associated with lower post-PCI angiography-derived FFR values (0.91 ± 0.05 vs. 0.94 ± 0.05; p = 0.001) and larger rate of suboptimal post-PCI physiology (43.0 vs. 22.7%; p = 0.001), as compared to focal CAD. At the median follow-up time of 37 months (33-58), post-PCI suboptimal physiology was related to a higher risk of VOCE (16.2% vs. 7.6%; HR: 2.311; 95% CI 1.410-3.794; p = 0.0009), while no significant difference was noted according to baseline physiological pattern. In diffuse disease, the use of intracoronary imaging was associated with a lower incidence of long-term VOCE (5.1% vs 14.8%; HR: 0.313, 95% CI 0.167-0.614, p = 0.030).

Conclusions: Suboptimal post-PCI physiology is observed more often in diffusely diseased arteries and it is associated with higher risk of VOCE at follow-up. The use of intravascular imaging might improve clinical outcomes in the setting of diffuse CAD.

Keywords: Angiography-derived physiology; Intracoronary imaging; Percutaneous coronary intervention; Physiological pattern of coronary disease; Quantitative flow ratio.

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Conflict of interest statement

Declarations. Conflict of interest: ST is the co-founder of Pulse Medical, reports research grants and consultancy from Pulse Medical. WW reports grants and consulting fees from MicroPort, outside the submitted work, and medical advisor of Corrib Core Laboratory and Rede Optimus, co-founder of Argonauts, an innovation facilitator. RS reports speaker fees from Abbott Vascular and research grant from Philips and Abbott. FR reports research grant from Philips and Abbott. All other authors report no competing interests.

Figures

Fig. 1
Fig. 1
A Correlation between pre-PCI QVPi and post-PCI angiography-derived FFR (left) and between pre-PCI dQFR/ds and post-PCI angiography-derived FFR (right). B Correlation between pre-PCI QVPi and % μFR/QFR increase after PCI (left) and between pre-PCI dQFR/ds and % μFR/QFR increase after PCI (right). PCI percutaneous coronary intervention; μFR Murray law quantitative flow ratio; QFR quantitative flow ratio; dQFR/ds instantaneous QFR gradient per unit length; QVPi virtual pullback pressure gradient index
Fig. 2
Fig. 2
A Post-PCI μFR/QFR (left) and % μFR/QFR increase after PCI (right) according to physiological pattern of disease. B Post-PCI μFR/QFR (left) and % μFR/QFR increase after PCI (right) according to the presence of major drops at the dQFR/ds. PCI percutaneous coronary intervention; μFR Murray law quantitative flow ratio; QFR quantitative flow ratio; dQFR/ds instantaneous QFR gradient per unit length; QVPi virtual pullback pressure gradient index
Fig. 3
Fig. 3
A Kaplan–Meier survival curves for 4 years VOCE according to sub-optimal post-PCI functional results (μFR/QFR ≤ 0.91). B1 Kaplan–Meier survival curves for 4 years VOCE according to the physiological pattern of CAD. B2 Kaplan–Meier survival curves for 4 years VOCE according to the physiological pattern of CAD stratified by the use of intravascular imaging. PCI percutaneous coronary intervention; μFR Murray law quantitative flow ratio; QFR quantitative flow ratio; VOCE vessel-oriented composite endpoint
See this image and copyright information in PMC

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