Physiological Distribution and Local Severity of Coronary Artery Disease and Outcomes After Percutaneous Coronary Intervention

传统PCI 部分流量储备 心脏病学 医学 经皮冠状动脉介入治疗 内科学 冠状动脉疾病 切断 心肌梗塞 冠状动脉造影 量子力学 物理
作者
Doosup Shin,Neng Dai,Seung Hun Lee,Ki Hong Choi,Adrien Lefieux,David Molony,Doyeon Hwang,Hyun Kuk Kim,Ki‐Hyun Jeon,Hyun‐Jong Lee,Ho‐Jun Jang,Sang Jin Ha,Taek Kyu Park,Jeong Hoon Yang,Young Bin Song,Joo‐Yong Hahn,Seung‐Hyuk Choi,Joon‐Hyung Doh,Eun‐Seok Shin,Chang‐Wook Nam,Bon‐Kwon Koo,Hyeon‐Cheol Gwon,Junbo Ge,Joo Myung Lee
出处
期刊:Jacc-cardiovascular Interventions [Elsevier BV]
卷期号:14 (16): 1771-1785 被引量:45
标识
DOI:10.1016/j.jcin.2021.06.013
摘要

The aim of this study was to evaluate prognostic implications of physiological 2-dimensional disease patterns on the basis of distribution and local severity of coronary atherosclerosis determined by quantitative flow ratio (QFR) virtual pull back.The beneficial effect of percutaneous coronary intervention (PCI) is determined by physiological distribution and local severity of coronary atherosclerosis.The study population included 341 patients who underwent angiographically successful PCI and post-PCI fractional flow reserve (FFR) measurement. Using pre-PCI virtual pull backs of QFR, physiological distribution was determined by pull back pressure gradient index, with a cutoff value of 0.78 to define predominant focal versus diffuse disease. Physiological local severity was assessed by instantaneous QFR gradient per unit length, with a cutoff value of ≥0.025/mm to define a major gradient. Suboptimal post-PCI physiological results were defined as both post-PCI FFR ≤0.85 and percentage FFR increase ≤15%. Clinical outcome was assessed by target vessel failure (TVF) at 2 years.QFR pull back pressure gradient index was correlated with post-PCI FFR (R = 0.423; P < 0.001), and instantaneous QFR gradient per unit length was correlated with percentage FFR increase (R = 0.370; P < 0.001). Using the 2 QFR-derived indexes, disease patterns were classified into 4 categories: predominant focal disease with and without major gradient (group 1 [n = 150] and group 2 [n = 21], respectively) and predominant diffuse disease with and without major gradient (group 3 [n = 115] and group 4 [n = 55], respectively). Proportions of suboptimal post-PCI physiological results were significantly different according to the 4 disease patterns (18.7%, 23.8%, 22.6%, and 56.4% from group 1 to group 4, respectively; P < 0.001). Cumulative incidence of TVF after PCI was significantly higher in patients with predominant diffuse disease (8.1% in group 3 and 9.9% in group 4 vs 1.4% in group 1 and 0.0% in group 2; overall P = 0.024).Both physiological distribution and local severity of coronary atherosclerosis could be characterized without pressure-wire pull backs, which determined post-PCI physiological results. After successful PCI, TVF risk was determined mainly by the physiological distribution of coronary atherosclerosis. (Automated Algorithm Detecting Physiologic Major Stenosis and Its Relationship With Post-PCI Clinical Outcomes [Algorithm-PCI], NCT04304677; Influence of FFR on the Clinical Outcome After Percutaneous Coronary Intervention [PERSPECTIVE], NCT01873560).
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