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

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:https://doi.org/10.4244/EIJ-D-23-00516

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

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 TateishiMasato 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

Research output: Contribution to journal › Article › Academic › peer-review

2 Citations (Scopus)

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.

Original language	English
Pages (from-to)	e891-e902
Journal	Eurointervention
Volume	19
Issue number	11
DOIs	https://doi.org/10.4244/EIJ-D-23-00516
Publication status	Published - 18 Dec 2023

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Kotoku, N., Ninomiya, K., Masuda, S., O'Leary, N., Garg, S., Naito, M., Miyashita, K., Tobe, A., Kageyama, S., Tsai, T. Y., Revaiah, P. C., Tu, S., Kozuma, K., Kawashima, H., Ishibashi, Y., Nakazawa, G., Takahashi, K., Okamura, T., Miyazaki, Y., ... Serruys, P. W. (2023). Preprocedural physiological assessment of coronary disease patterns to predict haemodynamic outcomes post-PCI. Eurointervention, 19(11), e891-e902. https://doi.org/10.4244/EIJ-D-23-00516

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title = "Preprocedural physiological assessment of coronary disease patterns to predict haemodynamic outcomes post-PCI",

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.",

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

year = "2023",

month = dec,

day = "18",

doi = "https://doi.org/10.4244/EIJ-D-23-00516",

language = "English",

volume = "19",

pages = "e891--e902",

journal = "Eurointervention",

issn = "1774-024X",

publisher = "EuroPCR",

number = "11",

}

Kotoku, N, Ninomiya, K, Masuda, S, O'Leary, N, Garg, S, Naito, M, Miyashita, K, Tobe, A, Kageyama, S, Tsai, TY, Revaiah, PC, Tu, S, Kozuma, K, Kawashima, H, Ishibashi, Y, Nakazawa, G, Takahashi, K, Okamura, T, Miyazaki, Y, Tateishi, H, Nakamura, M, Kogame, N, Asano, T, Nakatani, S, Morino, Y, Ishida, M, Katagiri, Y, Ono, M, Hara, H, Sotomi, Y, Tanabe, K, Ozaki, Y, Muramatsu, T, Dijkstra, J, Onuma, Y & Serruys, PW 2023, 'Preprocedural physiological assessment of coronary disease patterns to predict haemodynamic outcomes post-PCI', Eurointervention, vol. 19, no. 11, pp. e891-e902. https://doi.org/10.4244/EIJ-D-23-00516

TY - JOUR

T1 - Preprocedural physiological assessment of coronary disease patterns to predict haemodynamic outcomes post-PCI

AU - Kotoku, Nozomi

AU - Ninomiya, Kai

AU - Masuda, Shinichiro

AU - O'Leary, Neil

AU - Garg, Scot

AU - Naito, Mareka

AU - Miyashita, Kotaro

AU - Tobe, Akihiro

AU - Kageyama, Shigetaka

AU - Tsai, Tsung Ying

AU - Revaiah, Pruthvi C.

AU - Tu, Shengxian

AU - Kozuma, Ken

AU - Kawashima, Hideyuki

AU - Ishibashi, Yuki

AU - Nakazawa, Gaku

AU - Takahashi, Kuniaki

AU - Okamura, Takayuki

AU - Miyazaki, Yosuke

AU - Tateishi, Hiroki

AU - Nakamura, Masato

AU - Kogame, Norihiro

AU - Asano, Taku

AU - Nakatani, Shimpei

AU - Morino, Yoshihiro

AU - Ishida, Masaru

AU - Katagiri, Yuki

AU - Ono, Masafumi

AU - Hara, Hironori

AU - Sotomi, Yohei

AU - Tanabe, Kengo

AU - Ozaki, Yukio

AU - Muramatsu, Takashi

AU - Dijkstra, Jouke

AU - Onuma, Yoshinobu

AU - Serruys, Patrick W.

PY - 2023/12/18

Y1 - 2023/12/18

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85180360880&partnerID=8YFLogxK

U2 - https://doi.org/10.4244/EIJ-D-23-00516

DO - https://doi.org/10.4244/EIJ-D-23-00516

M3 - Article

C2 - 37960875

SN - 1774-024X

VL - 19

SP - e891-e902

JO - Eurointervention

JF - Eurointervention

IS - 11

ER -

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

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