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

Introduction

Coronary artery disease (CAD) is a common cardiovascular disorder that affects millions of people worldwide. Percutaneous coronary intervention (PCI) is an established treatment for CAD. However, the safety and efficacy of PCI may be affected by the presence of diffuse CAD. Therefore, it is crucial to understand the impact of CAD patterns on procedural outcomes.

Methodology

In a study published in the May 2024 issue of Cardiology by Collet et al., researchers aimed to investigate the influence of pathophysiological patterns of CAD on immediate PCI outcomes. The study utilized fractional flow reserve (FFR) pullbacks to measure CAD patterns, including pullback pressure gradient (PPG). The researchers conducted a prospective study, enrolling patients with at least one epicardial lesion requiring PCI due to an FFR ≤ 0.80. The primary outcome was optimal revascularization, defined as achieving a post-PCI FFR ≥ 0.88. The researchers used manual FFR pullbacks to calculate PPG.

Results

The study included 993 patients with 1,044 vessels. The mean FFR was (0.68 ± 0.12), PPG (0.62 ± 0.17), and post-PCI FFR (0.87 ± 0.07). PPG strongly correlated with FFR change after PCI (r=0.65, 95% CI 0.61-0.69, P<0.001) and predicted optimal revascularization well (AUC 0.82, 95% CI 0.79-0.84, P<0.001). The researchers found that FFR alone did not predict outcomes (AUC 0.54, 95% CI 0.50-0.57). The treatment decisions were influenced by PPG in 14% of patients, redirecting them from PCI to alternative treatment. The study also showed that low PPG (<0.62) increased myocardial infarction risk compared to those with focal disease (OR 1.71, 95% CI 1.00-2.97).

Discussion

The study’s findings suggest that CAD patterns significantly impact PCI outcomes. PPG measurement using manual FFR pullbacks provides important insights into CAD patterns and their influence on procedural outcomes. PPG was highly predictive of optimal revascularization and offered additional insights beyond FFR measurements. The use of PPG can help identify patients who may benefit from alternative treatments and reduce the risks associated with PCI.

Conclusion

In conclusion, the study by Collet et al. highlights the importance of understanding the impact of CAD patterns on procedural outcomes. PPG measurement, in addition to FFR, provides valuable information that can help clinicians make informed decisions about the best treatment options for patients. The use of PPG can lead to better patient outcomes and reduce the risks associated with PCI.

Originally Post From https://www.physiciansweekly.com/impact-of-coronary-artery-disease-patterns-on-immediate-pci-results/

Impact of Coronary Artery Disease Patterns on Immediate PCI Results – Physician’s Weekly