Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes

Carlos Collet; Daniel Munhoz; Takuya Mizukami; Jeroen Sonck; Hitoshi Matsuo; Toshiro Shinke; Hirohiko Ando; Brian Ko; Simone Biscaglia; Fernando Rivero; Thomas Engstrøm; Ketina Arslani; Antonio Maria Leone; Lokien X van Nunen; William F Fearon; Evald Høj Christiansen; Stephane Fournier; Liyew Desta; Andy Yong; Julien Adjej; Javier Escaned; Masafumi Nakayama; Ashkan Eftekhari; Frederik M Zimmermann; Koshiro Sakai; Tatyana Storozhenko; Bruno R da Costa; Gianluca Campo; Nick E J West; Tom De Potter; Ward Heggermont; Dimitri Buytaert; Jozef Bartunek; Colin Berry; Damien Collison; Thomas Johnson; Tetsuya Amano; Divaka Perera; Allen Jeremias; Ziad Ali; Nico H J Pijls; Bernard De Bruyne; Nils P Johnson

doi:10.1161/CIRCULATIONAHA.124.069450

Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes

Carlos Collet, Daniel Munhoz, Takuya Mizukami, Jeroen Sonck, Hitoshi Matsuo, Toshiro Shinke, Hirohiko Ando, Brian Ko, Simone Biscaglia, Fernando Rivero, Thomas Engstrøm, Ketina Arslani, Antonio Maria Leone, Lokien X van Nunen, William F Fearon, Evald Høj Christiansen, Stephane Fournier, Liyew Desta, Andy Yong, Julien AdjejJavier Escaned, Masafumi Nakayama, Ashkan Eftekhari, Frederik M Zimmermann, Koshiro Sakai, Tatyana Storozhenko, Bruno R da Costa, Gianluca Campo, Nick E J West, Tom De Potter, Ward Heggermont, Dimitri Buytaert, Jozef Bartunek, Colin Berry, Damien Collison, Thomas Johnson, Tetsuya Amano, Divaka Perera, Allen Jeremias, Ziad Ali, Nico H J Pijls, Bernard De Bruyne, Nils P Johnson^*

^*Corresponding author af dette arbejde

Afdeling for Hjertesygdomme

Abstract

BACKGROUND: Diffuse coronary artery disease affects the safety and efficacy of percutaneous coronary intervention (PCI). Pathophysiologic coronary artery disease patterns can be quantified using fractional flow reserve (FFR) pullbacks incorporating the pullback pressure gradient (PPG) calculation. This study aimed to establish the capacity of PPG to predict optimal revascularization and procedural outcomes.

METHODS: This prospective, investigator-initiated, single-arm, multicenter study enrolled patients with at least one epicardial lesion with an FFR ≤0.80 scheduled for PCI. Manual FFR pullbacks were used to calculate PPG. The primary outcome of optimal revascularization was defined as an FFR ≥0.88 after PCI.

RESULTS: A total of 993 patients with 1044 vessels were included. The mean FFR was 0.68±0.12, PPG 0.62±0.17, and the post-PCI FFR was 0.87±0.07. PPG was significantly correlated with the change in FFR after PCI (r=0.65 [95% CI, 0.61-0.69]; P<0.001) and demonstrated excellent predictive capacity for optimal revascularization (area under the receiver operating characteristic curve, 0.82 [95% CI, 0.79-0.84]; P<0.001). FFR alone did not predict revascularization outcomes (area under the receiver operating characteristic curve, 0.54 [95% CI, 0.50-0.57]). PPG influenced treatment decisions in 14% of patients, redirecting them from PCI to alternative treatment modalities. Periprocedural myocardial infarction occurred more frequently in patients with low PPG (<0.62) compared with those with focal disease (odds ratio, 1.71 [95% CI, 1.00-2.97]).

CONCLUSIONS: 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.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04789317.

Originalsprog	Engelsk
Tidsskrift	Circulation
Vol/bind	150
Udgave nummer	8
Sider (fra-til)	586-597
Antal sider	12
ISSN	0009-7322
DOI	https://doi.org/10.1161/CIRCULATIONAHA.124.069450
Status	Udgivet - 20 aug. 2024

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10.1161/CIRCULATIONAHA.124.069450

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Collet, C., Munhoz, D., Mizukami, T., Sonck, J., Matsuo, H., Shinke, T., Ando, H., Ko, B., Biscaglia, S., Rivero, F., Engstrøm, T., Arslani, K., Leone, A. M., van Nunen, L. X., Fearon, W. F., Christiansen, E. H., Fournier, S., Desta, L., Yong, A., ... Johnson, N. P. (2024). Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes. Circulation, 150(8), 586-597. https://doi.org/10.1161/CIRCULATIONAHA.124.069450

Collet, C, Munhoz, D, Mizukami, T, Sonck, J, Matsuo, H, Shinke, T, Ando, H, Ko, B, Biscaglia, S, Rivero, F, Engstrøm, T , Arslani, K, Leone, AM, van Nunen, LX, Fearon, WF, Christiansen, EH, Fournier, S, Desta, L, Yong, A, Adjej, J, Escaned, J, Nakayama, M, Eftekhari, A, Zimmermann, FM, Sakai, K, Storozhenko, T, da Costa, BR, Campo, G, West, NEJ, De Potter, T, Heggermont, W, Buytaert, D, Bartunek, J, Berry, C, Collison, D, Johnson, T, Amano, T, Perera, D, Jeremias, A, Ali, Z, Pijls, NHJ, De Bruyne, B & Johnson, NP 2024, 'Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes', Circulation, bind 150, nr. 8, s. 586-597. https://doi.org/10.1161/CIRCULATIONAHA.124.069450

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title = "Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes",

abstract = "BACKGROUND: Diffuse coronary artery disease affects the safety and efficacy of percutaneous coronary intervention (PCI). Pathophysiologic coronary artery disease patterns can be quantified using fractional flow reserve (FFR) pullbacks incorporating the pullback pressure gradient (PPG) calculation. This study aimed to establish the capacity of PPG to predict optimal revascularization and procedural outcomes.METHODS: This prospective, investigator-initiated, single-arm, multicenter study enrolled patients with at least one epicardial lesion with an FFR ≤0.80 scheduled for PCI. Manual FFR pullbacks were used to calculate PPG. The primary outcome of optimal revascularization was defined as an FFR ≥0.88 after PCI.RESULTS: A total of 993 patients with 1044 vessels were included. The mean FFR was 0.68±0.12, PPG 0.62±0.17, and the post-PCI FFR was 0.87±0.07. PPG was significantly correlated with the change in FFR after PCI (r=0.65 [95% CI, 0.61-0.69]; P<0.001) and demonstrated excellent predictive capacity for optimal revascularization (area under the receiver operating characteristic curve, 0.82 [95% CI, 0.79-0.84]; P<0.001). FFR alone did not predict revascularization outcomes (area under the receiver operating characteristic curve, 0.54 [95% CI, 0.50-0.57]). PPG influenced treatment decisions in 14% of patients, redirecting them from PCI to alternative treatment modalities. Periprocedural myocardial infarction occurred more frequently in patients with low PPG (<0.62) compared with those with focal disease (odds ratio, 1.71 [95% CI, 1.00-2.97]).CONCLUSIONS: 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.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04789317.",

keywords = "Aged, Coronary Artery Disease/physiopathology, Female, Fractional Flow Reserve, Myocardial, Humans, Male, Middle Aged, Percutaneous Coronary Intervention/adverse effects, Prospective Studies, Treatment Outcome",

author = "Carlos Collet and Daniel Munhoz and Takuya Mizukami and Jeroen Sonck and Hitoshi Matsuo and Toshiro Shinke and Hirohiko Ando and Brian Ko and Simone Biscaglia and Fernando Rivero and Thomas Engstr{\o}m and Ketina Arslani and Leone, {Antonio Maria} and {van Nunen}, {Lokien X} and Fearon, {William F} and Christiansen, {Evald H{\o}j} and Stephane Fournier and Liyew Desta and Andy Yong and Julien Adjej and Javier Escaned and Masafumi Nakayama and Ashkan Eftekhari and Zimmermann, {Frederik M} and Koshiro Sakai and Tatyana Storozhenko and {da Costa}, {Bruno R} and Gianluca Campo and West, {Nick E J} and {De Potter}, Tom and Ward Heggermont and Dimitri Buytaert and Jozef Bartunek and Colin Berry and Damien Collison and Thomas Johnson and Tetsuya Amano and Divaka Perera and Allen Jeremias and Ziad Ali and Pijls, {Nico H J} and {De Bruyne}, Bernard and Johnson, {Nils P}",

year = "2024",

month = aug,

day = "20",

doi = "10.1161/CIRCULATIONAHA.124.069450",

language = "English",

volume = "150",

pages = "586--597",

journal = "Circulation",

issn = "0009-7322",

publisher = "Lippincott Williams & Wilkins",

number = "8",

}

TY - JOUR

T1 - Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes

AU - Collet, Carlos

AU - Munhoz, Daniel

AU - Mizukami, Takuya

AU - Sonck, Jeroen

AU - Matsuo, Hitoshi

AU - Shinke, Toshiro

AU - Ando, Hirohiko

AU - Ko, Brian

AU - Biscaglia, Simone

AU - Rivero, Fernando

AU - Engstrøm, Thomas

AU - Arslani, Ketina

AU - Leone, Antonio Maria

AU - van Nunen, Lokien X

AU - Fearon, William F

AU - Christiansen, Evald Høj

AU - Fournier, Stephane

AU - Desta, Liyew

AU - Yong, Andy

AU - Adjej, Julien

AU - Escaned, Javier

AU - Nakayama, Masafumi

AU - Eftekhari, Ashkan

AU - Zimmermann, Frederik M

AU - Sakai, Koshiro

AU - Storozhenko, Tatyana

AU - da Costa, Bruno R

AU - Campo, Gianluca

AU - West, Nick E J

AU - De Potter, Tom

AU - Heggermont, Ward

AU - Buytaert, Dimitri

AU - Bartunek, Jozef

AU - Berry, Colin

AU - Collison, Damien

AU - Johnson, Thomas

AU - Amano, Tetsuya

AU - Perera, Divaka

AU - Jeremias, Allen

AU - Ali, Ziad

AU - Pijls, Nico H J

AU - De Bruyne, Bernard

AU - Johnson, Nils P

PY - 2024/8/20

Y1 - 2024/8/20

N2 - BACKGROUND: Diffuse coronary artery disease affects the safety and efficacy of percutaneous coronary intervention (PCI). Pathophysiologic coronary artery disease patterns can be quantified using fractional flow reserve (FFR) pullbacks incorporating the pullback pressure gradient (PPG) calculation. This study aimed to establish the capacity of PPG to predict optimal revascularization and procedural outcomes.METHODS: This prospective, investigator-initiated, single-arm, multicenter study enrolled patients with at least one epicardial lesion with an FFR ≤0.80 scheduled for PCI. Manual FFR pullbacks were used to calculate PPG. The primary outcome of optimal revascularization was defined as an FFR ≥0.88 after PCI.RESULTS: A total of 993 patients with 1044 vessels were included. The mean FFR was 0.68±0.12, PPG 0.62±0.17, and the post-PCI FFR was 0.87±0.07. PPG was significantly correlated with the change in FFR after PCI (r=0.65 [95% CI, 0.61-0.69]; P<0.001) and demonstrated excellent predictive capacity for optimal revascularization (area under the receiver operating characteristic curve, 0.82 [95% CI, 0.79-0.84]; P<0.001). FFR alone did not predict revascularization outcomes (area under the receiver operating characteristic curve, 0.54 [95% CI, 0.50-0.57]). PPG influenced treatment decisions in 14% of patients, redirecting them from PCI to alternative treatment modalities. Periprocedural myocardial infarction occurred more frequently in patients with low PPG (<0.62) compared with those with focal disease (odds ratio, 1.71 [95% CI, 1.00-2.97]).CONCLUSIONS: 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.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04789317.

AB - BACKGROUND: Diffuse coronary artery disease affects the safety and efficacy of percutaneous coronary intervention (PCI). Pathophysiologic coronary artery disease patterns can be quantified using fractional flow reserve (FFR) pullbacks incorporating the pullback pressure gradient (PPG) calculation. This study aimed to establish the capacity of PPG to predict optimal revascularization and procedural outcomes.METHODS: This prospective, investigator-initiated, single-arm, multicenter study enrolled patients with at least one epicardial lesion with an FFR ≤0.80 scheduled for PCI. Manual FFR pullbacks were used to calculate PPG. The primary outcome of optimal revascularization was defined as an FFR ≥0.88 after PCI.RESULTS: A total of 993 patients with 1044 vessels were included. The mean FFR was 0.68±0.12, PPG 0.62±0.17, and the post-PCI FFR was 0.87±0.07. PPG was significantly correlated with the change in FFR after PCI (r=0.65 [95% CI, 0.61-0.69]; P<0.001) and demonstrated excellent predictive capacity for optimal revascularization (area under the receiver operating characteristic curve, 0.82 [95% CI, 0.79-0.84]; P<0.001). FFR alone did not predict revascularization outcomes (area under the receiver operating characteristic curve, 0.54 [95% CI, 0.50-0.57]). PPG influenced treatment decisions in 14% of patients, redirecting them from PCI to alternative treatment modalities. Periprocedural myocardial infarction occurred more frequently in patients with low PPG (<0.62) compared with those with focal disease (odds ratio, 1.71 [95% CI, 1.00-2.97]).CONCLUSIONS: 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.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04789317.

KW - Aged

KW - Coronary Artery Disease/physiopathology

KW - Female

KW - Fractional Flow Reserve, Myocardial

KW - Humans

KW - Male

KW - Middle Aged

KW - Percutaneous Coronary Intervention/adverse effects

KW - Prospective Studies

KW - Treatment Outcome

UR - http://www.scopus.com/inward/record.url?scp=85201755411&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.124.069450

DO - 10.1161/CIRCULATIONAHA.124.069450

M3 - Journal article

C2 - 38742491

SN - 0009-7322

VL - 150

SP - 586

EP - 597

JO - Circulation

JF - Circulation

IS - 8

ER -

Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes

Abstract

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