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...

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