Integrated coronary disease burden and patterns to discriminate vessels benefiting from percutaneous coronary intervention.

Abstract

OBJECTIVE:

To evaluate the prognostic implications of atherosclerosis functional pattern on ischemia-causing vessels received percutaneous coronary intervention (PCI) or conservative treatment.

BACKGROUND:

Quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) index is recently proposed to characterize atherosclerosis functional pattern, but its prognostic value remains unclear.

METHODS:

QFR-derived PPG index was retrospectively calculated in patients from the PANDA III trial. Vessels with low or high PPG treated by PCI or not were compared for the risk of 2-year vessel-oriented composite outcome (VOCO), which was a composite of vessel-related ischemia-driven revascularization, vessel-related myocardial infarction, or cardiac death.

RESULTS:

A total of 1444 vessels were included while 94 (6.5%) VOCOs occurred within 2 years. Among physiologically ischemic vessels (QFR ≤ 0.80) treated by PCI, those with low PPG acquired higher VOCO risk than those with high PPG (8.4% vs. 3.8%; adjusted hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.18 to 3.86), and a similar VOCO risk (8.4% vs. 7.8%; adjusted HR 1.11, 95%CI 0.70-1.78) compared to those treated by conservatively. After multiple adjustment, PPG index was an independent predictor for VOCO (HR 1.30, 95% CI 1.05-1.62). The addition of PPG to the model of clinical risk factors substantially improved the predictions of VOCO (C-index 0.67 vs. 0.62, net reclassification index 0.42).

CONCLUSIONS:

PCI treatment was associated with improved outcomes in vessels with high PPG, but not for those with low PPG, which acquired similar risk of VOCO compared to vessels treated conservatively. QFR-derived PPG might assist the treatment strategy selection in ischemia-causing vessels.

• Authors: Neng Dai, Rui Zhang, Nan Hu, Changdong Guan, Tongqiang Zou, Zheng Qiao, Min Zhang, Shaofeng Duan, Lihua Xie, Kefei Dou, Yingmei Zhang, Bo Xu, Junbo Ge
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 99 Issue 1 Pg. E12-E21 (01 01 2022) ISSN: 1522-726X [Electronic] United States
• PMID: 34652068 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 Wiley Periodicals LLC.

Topics

• Coronary Angiography
• Coronary Artery Disease (diagnostic imaging, therapy)
• Coronary Vessels (diagnostic imaging, surgery)
• Fractional Flow Reserve, Myocardial
• Humans
• Percutaneous Coronary Intervention
• Predictive Value of Tests
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome