Nozomi Kotoku; Kai Ninomiya; Shinichiro Masuda; Neil O’Leary; Scot Garg; Mareka Naito; Kotaro Miyashita; Akihiro Tobe; Shigetaka Kageyama; Tsung Ying Tsai; Pruthvi  C. Revaiah; Shengxian Tu; Ken Kozuma; Hideyuki Kawashima; Yuki Ishibashi; Gaku Nakazawa; Kuniaki Takahashi; Takayuki Okamura; Yosuke Miyazaki; Hiroki Tateishi; Masato Nakamura; Norihiro Kogame; Taku Asano; Shimpei Nakatani; Yoshihiro Morino; Masaru Ishida; Yuki Katagiri; Masafumi Ono; Hironori Hara; Yohei Sotomi; Kengo Tanabe; Yukio Ozaki; Takashi Muramatsu; Jouke Dijkstra; Yoshinobu Onuma; Patrick  W. Serruys

doi:10.4244/EIJ-D-23-00516

Preprocedural physiological assessment of coronary disease patterns to predict haemodynamic outcomes post-PCI

Nozomi Kotoku¹, MD; Kai Ninomiya¹, MD; Shinichiro Masuda¹, MD; Neil O’Leary¹, PhD; Scot Garg²^,³, MD, PhD; Mareka Naito¹, MD; Kotaro Miyashita¹, MD; Akihiro Tobe¹, MD; Shigetaka Kageyama¹, MD; Tsung Ying Tsai¹, MD; Pruthvi C. Revaiah¹, MD; Shengxian Tu⁴, PhD; Ken Kozuma⁵, MD, PhD; Hideyuki Kawashima⁵, MD, PhD; Yuki Ishibashi⁶, MD, PhD; Gaku Nakazawa⁷, MD, PhD; Kuniaki Takahashi⁷, MD, PhD; Takayuki Okamura⁸, MD, PhD; Yosuke Miyazaki⁸, MD, PhD; Hiroki Tateishi⁸^,⁹, MD, PhD; Masato Nakamura¹⁰, MD, PhD; Norihiro Kogame¹⁰^,¹¹, MD, PhD; Taku Asano¹², MD, PhD; Shimpei Nakatani¹³, MD, PhD; Yoshihiro Morino¹⁴, MD, PhD; Masaru Ishida¹⁴, MD, PhD; Yuki Katagiri¹⁵, MD, PhD; Masafumi Ono¹², MD, PhD; Hironori Hara¹⁶, MD; Yohei Sotomi¹⁷, MD, PhD; Kengo Tanabe¹⁸, MD, PhD; Yukio Ozaki¹⁹, MD, PhD; Takashi Muramatsu²⁰, MD, PhD; Jouke Dijkstra²¹, PhD; Yoshinobu Onuma¹, MD, PhD; Patrick W. Serruys¹, MD, PhD

Abstract

Background: Even with intracoronary imaging-guided stent optimisation, suboptimal haemodynamic outcomes post-percutaneous coronary intervention (PCI) can be related to residual lesions in non-stented segments. Preprocedural assessment of pathophysiological coronary artery disease (CAD) patterns could help predict the physiological response to PCI.

Aims: The aim of this study was to assess the relationship between preprocedural pathophysiological haemodynamic patterns and intracoronary imaging findings, as well as their association with physiological outcomes immediately post-PCI.

Methods: Data from 206 patients with chronic coronary syndrome enrolled in the ASET-JAPAN study were analysed. Pathophysiological CAD patterns were characterised using Murray law-based quantitative flow ratio (μQFR)-derived indices acquired from pre-PCI angiograms. The diffuseness of CAD was defined by the pullback pressure gradient (PPG) index. Intracoronary imaging in stented segments after stent optimisation was also analysed.

Results: In the multivariable analysis, diffuse disease − defined by the pre-PCI μQFR-PPG index − was an independent factor for predicting a post-PCI μQFR <0.91 (per 0.1 decrease of PPG index, odds ratio 1.57, 95% confidence interval: 1.07-2.34; p=0.022), whereas the stent expansion index (EI) was not associated with a suboptimal post-PCI μQFR. Among vessels with an EI ≥80% and post-PCI μQFR <0.91, 84.0% of those vessels had a diffuse pattern preprocedure. There was no significant difference in EI between vessels with diffuse disease and those with focal disease. The average plaque burden in the stented segment was significantly larger in vessels with a preprocedural diffuse CAD pattern.

Conclusions: A physiological diffuse pattern preprocedure was an independent factor in predicting unfavourable immediate haemodynamic outcomes post-PCI, even after stent optimisation using intracoronary imaging. Preprocedural assessment of CAD patterns could identify patients who are likely to exhibit superior immediate haemodynamic outcomes following PCI.

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