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Randomized Controlled Trial
. 2025 Jan 17;15(1):2228.
doi: 10.1038/s41598-025-85872-9.

Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes

Shigetaka Kageyama  1   2   3 , Pruthvi Chenniganahosahalli Revaiah  1   2 , Tsai Tsung-Ying  1   2 , Kotaro Miyashita  1   2 , Akihiro Tobe  1   2 , Neil O'Leary  4 , Johan H C Reiber  5 , Shengxian Tu  6 , Azfar Zaman  7 , Manel Sabaté  8 , Helge Möllmann  9 , Faisal Sharif  1 , Julien Lemoine  10 , Adrian Wlodarczak  11 , Scot Garg  12 , Yoshinobu Onuma  1   2   13 , Patrick W Serruys  14   15   16
Affiliations
Randomized Controlled Trial

Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes

Shigetaka Kageyama et al. Sci Rep. .

Abstract

Diffuse coronary artery disease (CAD) impacts the immediate hemodynamic and clinical outcomes of percutaneous coronary intervention (PCI). We evaluated whether the diffuse pattern of CAD derived from angiographic Quantitative flow ratio (QFR) impacts the immediate hemodynamic outcome post-PCI and the medium term predicted vessel-oriented composite endpoint (VOCE). Paired pre-procedure QFRs were assessed in 503 patients and 1022 vessels in the Multivessel TALENT (MVT) trial. The pathophysiological pattern of CAD was defined as "predominantly diffuse" or "focal" according to a virtual QFR pullback pressure gradient (PPG) index < 0.78 and ≥ 0.78, respectively. Physiological "focal severity" was assessed using the QFR gradient per mm (dQFR/ds), with a value ≥ 0.025/mm the threshold for a "major gradient". A post-PCI QFR ≥ 0.91 was considered optimal. Median pre-PCI PPG index was 0.70 (IQR 0.59-0.80). The prevalence of "predominantly diffuse" CAD and "major gradient" were 68.6% and 85.8%, respectively. A "Predominantly diffuse" pattern with a major gradient had a higher risk of a post-PCI QFR < 0.91 (OR 1.52,95%CI 1.47-1.58). In multivariable analysis, low QFR PPG index (diffuse disease) was an independent determinant of a post-PCI QFR < 0.91 (per 0.1 decrease of QFR PPG index, OR:9.8, 95% CI 3.0-32.2, p < 0.001). Based on post-PCI QFR the predicted 2-year VOCE, a powered endpoint in the MVT trial, was 6.1% and 4.2% in diffuse and focal lesions, respectively. A pre-procedure physiological pattern of diffuse CAD is an independent determinant of an unfavourable immediate hemodynamic outcome post-PCI, and detrimentally affects the predicted 2-year VOCE.Clinical Trial Registration URL: https://www.clinicaltrials.gov/ct2/show/NCT04390672 Unique Identifier: NCT04390672 (registration date 15/05/2020).

Keywords: Acute coronary syndrome; Chronic coronary syndrome; Coronary artery disease; Disease pattern; Drug-eluting stent; Multiple vessel disease; Percutaneous coronary intervention; Quantitative flow ratio.

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Conflict of interest statement

Declarations. Competing interests: Dr Serruys reports institutional grants from Philips/Volcano, SMT, Novartis, Xeltis, Merillife, outside the submitted work. Dr Tu reports research grants and consultancy from Pulse Medical. Dr Sabaté has received consultant fees from Abbott Vascular and Ivascular outside the submitted work. Dr Möllmann reports speaker honoraria from Abbott, Boston Scientific, and SMT. All other authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Study flowchart. Abbreviations: QFR, quantitative flow ratio; μFR, Murray low-based quantitative flow ratio; dQFR/ds, instantaneous QFR ratio gradient per unit length.
Fig. 2
Fig. 2
Pathophysiological pattern distribution with 4 quadrants and post PCI-QFR values with proportion of optimal post-procedural QFR (≥ 0.91). Abbreviations: PCI, percutaneous coronary intervention; QFR, quantitative flow ratio.
Fig. 3
Fig. 3
Cumulative frequency of pre- and post-PCI QFR in 2 groups. Left panel showed cumulative curves of both pre- and post-PCI QFR in predominantly focal disease defined by QFR PPG index at pre-PCI (≥ 0.78) and right panel showed those in predominantly diffuse disease (QFR PPG index < 0.78). Abbreviations: PCI, percutaneous coronary intervention; QFR, quantitative flow ratio; PPG, pressure pullback curve gradient.
Fig. 4
Fig. 4
Relation between pre-PCI PPG index and odds ratio of optimal post-PCI QFR. Cubic spline curve showing the odds ratio of optimal post-PCI QFR (vertical axis) according to the pre-PCI QFR PPG index (horizontal axis). Abbreviations: PCI, percutaneous coronary intervention; QFR, quantitative flow ratio; PPG, pullback pressure curve gradient.
See this image and copyright information in PMC

References

    1. Serruys, P. W., Kageyama, S., Garg, S. & Onuma, Y. In the beginning there was angina pectoris, at the end there was still angina pectoris. JACC Cardiovasc. Interv.15, 2519–2522 (2022). - PubMed
    1. Kogame, N. et al. The impact of coronary physiology on contemporary clinical decision making. Jacc-Cardiovasc. Interv.13, 1617–1638 (2020). - PubMed
    1. Biscaglia, S. et al. Invasive coronary physiology after stent implantation. Jacc-Cardiovasc. Interven.14, 237–246 (2021). - PubMed
    1. Tebaldi, M. et al. Evolving routine standards in invasive hemodynamic assessment of coronary stenosis The Nationwide Italian SICI-GISE cross-sectional ERIS study. Jacc-Cardiovasc. Interven.11, 1482–1491 (2018). - PubMed
    1. Kogame, N. et al. Clinical implication of quantitative flow ratio after percutaneous coronary intervention for 3-vessel disease. Jacc-Cardiovasc. Interven.12, 2064–2075 (2019). - PubMed

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