Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease
Background Coronary artery disease (CAD) patterns play an essential role in the decision‐making process about revascularization. The pullback pressure gradient (PPG) quantifies CAD patterns as either focal or diffuse based on fractional flow reserve (FFR) pullbacks. The objective of this study was t...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.026960 |
| _version_ | 1811170027682922496 |
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| author | Takuya Mizukami Jeroen Sonck Koshiro Sakai Brian Ko Michael Maeng Hiromasa Otake Bon‐Kwon Koo Sakura Nagumo Bjarne L. Nørgaard Jonathon Leipsic Toshiro Shinke Daniel Munhoz Niya Mileva Marta Belmonte Hirofumi Ohashi Emanuele Barbato Nils P. Johnson Bernard De Bruyne Carlos Collet |
| author_facet | Takuya Mizukami Jeroen Sonck Koshiro Sakai Brian Ko Michael Maeng Hiromasa Otake Bon‐Kwon Koo Sakura Nagumo Bjarne L. Nørgaard Jonathon Leipsic Toshiro Shinke Daniel Munhoz Niya Mileva Marta Belmonte Hirofumi Ohashi Emanuele Barbato Nils P. Johnson Bernard De Bruyne Carlos Collet |
| author_sort | Takuya Mizukami |
| collection | DOAJ |
| description | Background Coronary artery disease (CAD) patterns play an essential role in the decision‐making process about revascularization. The pullback pressure gradient (PPG) quantifies CAD patterns as either focal or diffuse based on fractional flow reserve (FFR) pullbacks. The objective of this study was to evaluate the impact of CAD patterns on acute percutaneous coronary intervention (PCI) results considered surrogates of clinical outcomes. Methods and Results This was a prospective, multicenter study of patients with hemodynamically significant CAD undergoing PCI. Motorized FFR pullbacks and optical coherence tomography (OCT) were performed before and after PCI. Post‐PCI FFR >0.90 was considered an optimal result. Focal disease was defined as PPG >0.73 (highest PPG tertile). Overall, 113 patients (116 vessels) were included. Patients with focal disease were younger than those with diffuse CAD (61.4±9.9 versus 65.1±8.7 years, P=0.042). PCI in vessels with high PPG (focal CAD) resulted in higher post‐PCI FFR (0.91±0.07 in the focal group versus 0.86±0.05 in the diffuse group, P<0.001) and larger minimal stent area (6.3±2.3 mm2 in focal versus 5.3±1.8 mm2 in diffuse CAD, P=0.015) compared withvessels with low PPG (diffuse CAD). The PPG was associated with the change in FFR after PCI (R2=0.51, P<0.001). The PPG significantly improved the capacity to predict optimal PCI results compared with an angiographic assessment of CAD patterns (area under the curvePPG 0.81 [95% CI, 0.73–0.88] versus area under the curveangio 0.51 [95% CI, 0.42–0.60]; P<0.001). Conclusions PCI in vessels with focal disease defined by the PPG resulted in greater improvement in epicardial conductance and larger minimal stent area compared with diffuse disease. PPG, but not angiographically defined CAD patterns, distinguished patients attaining superior procedural outcomes. Registration URL: https://clinicaltrials.gov/ct2/show/NCT03782688 |
| first_indexed | 2024-04-10T16:51:48Z |
| format | Article |
| id | doaj.art-3caa0b43a122489eaccb4fb01d78af93 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T16:51:48Z |
| publishDate | 2022-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-3caa0b43a122489eaccb4fb01d78af932023-02-07T16:03:22ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-12-01112310.1161/JAHA.122.026960Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery DiseaseTakuya Mizukami0Jeroen Sonck1Koshiro Sakai2Brian Ko3Michael Maeng4Hiromasa Otake5Bon‐Kwon Koo6Sakura Nagumo7Bjarne L. Nørgaard8Jonathon Leipsic9Toshiro Shinke10Daniel Munhoz11Niya Mileva12Marta Belmonte13Hirofumi Ohashi14Emanuele Barbato15Nils P. Johnson16Bernard De Bruyne17Carlos Collet18Cardiovascular Center Aalst OLV Clinic Aalst BelgiumCardiovascular Center Aalst OLV Clinic Aalst BelgiumCardiovascular Center Aalst OLV Clinic Aalst BelgiumMonash Cardiovascular Research Centre Monash University and Monash Heart, Monash Health Clayton Victoria AustraliaDepartment of Cardiology Aarhus University Hospital Aarhus DenmarkDivision of Cardiovascular Medicine, Department of Internal Medicine Kobe University Graduate School of Medicine Kobe JapanDepartment of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul KoreaCardiovascular Center Aalst OLV Clinic Aalst BelgiumDepartment of Cardiology Aarhus University Hospital Aarhus DenmarkDepartment of Medicine and Radiology University of British Columbia Vancouver British Columbia CanadaDivision of Cardiology, Department of Medicine Showa University School of Medicine Tokyo JapanCardiovascular Center Aalst OLV Clinic Aalst BelgiumCardiovascular Center Aalst OLV Clinic Aalst BelgiumCardiovascular Center Aalst OLV Clinic Aalst BelgiumCardiovascular Center Aalst OLV Clinic Aalst BelgiumCardiovascular Center Aalst OLV Clinic Aalst BelgiumDivision of Cardiology, Department of Medicine, Weatherhead PET Center McGovern Medical School at UTHealth and Memorial Hermann Hospital Houston TXCardiovascular Center Aalst OLV Clinic Aalst BelgiumCardiovascular Center Aalst OLV Clinic Aalst BelgiumBackground Coronary artery disease (CAD) patterns play an essential role in the decision‐making process about revascularization. The pullback pressure gradient (PPG) quantifies CAD patterns as either focal or diffuse based on fractional flow reserve (FFR) pullbacks. The objective of this study was to evaluate the impact of CAD patterns on acute percutaneous coronary intervention (PCI) results considered surrogates of clinical outcomes. Methods and Results This was a prospective, multicenter study of patients with hemodynamically significant CAD undergoing PCI. Motorized FFR pullbacks and optical coherence tomography (OCT) were performed before and after PCI. Post‐PCI FFR >0.90 was considered an optimal result. Focal disease was defined as PPG >0.73 (highest PPG tertile). Overall, 113 patients (116 vessels) were included. Patients with focal disease were younger than those with diffuse CAD (61.4±9.9 versus 65.1±8.7 years, P=0.042). PCI in vessels with high PPG (focal CAD) resulted in higher post‐PCI FFR (0.91±0.07 in the focal group versus 0.86±0.05 in the diffuse group, P<0.001) and larger minimal stent area (6.3±2.3 mm2 in focal versus 5.3±1.8 mm2 in diffuse CAD, P=0.015) compared withvessels with low PPG (diffuse CAD). The PPG was associated with the change in FFR after PCI (R2=0.51, P<0.001). The PPG significantly improved the capacity to predict optimal PCI results compared with an angiographic assessment of CAD patterns (area under the curvePPG 0.81 [95% CI, 0.73–0.88] versus area under the curveangio 0.51 [95% CI, 0.42–0.60]; P<0.001). Conclusions PCI in vessels with focal disease defined by the PPG resulted in greater improvement in epicardial conductance and larger minimal stent area compared with diffuse disease. PPG, but not angiographically defined CAD patterns, distinguished patients attaining superior procedural outcomes. Registration URL: https://clinicaltrials.gov/ct2/show/NCT03782688https://www.ahajournals.org/doi/10.1161/JAHA.122.026960CAD patternsdiffuse diseasepercutaneous coronary interventionspullback pressure gradient |
| spellingShingle | Takuya Mizukami Jeroen Sonck Koshiro Sakai Brian Ko Michael Maeng Hiromasa Otake Bon‐Kwon Koo Sakura Nagumo Bjarne L. Nørgaard Jonathon Leipsic Toshiro Shinke Daniel Munhoz Niya Mileva Marta Belmonte Hirofumi Ohashi Emanuele Barbato Nils P. Johnson Bernard De Bruyne Carlos Collet Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease CAD patterns diffuse disease percutaneous coronary interventions pullback pressure gradient |
| title | Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease |
| title_full | Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease |
| title_fullStr | Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease |
| title_full_unstemmed | Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease |
| title_short | Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease |
| title_sort | procedural outcomes after percutaneous coronary interventions in focal and diffuse coronary artery disease |
| topic | CAD patterns diffuse disease percutaneous coronary interventions pullback pressure gradient |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.026960 |
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