Key result
Impaired post-PCI physiological assessment across all modalities was associated with an increased rate of major adverse cardiac events, vessel-orientated cardiac events, or target vessel failure (HR 2.32; 95% CI 1.71-3.16).
Why the study?
Despite optimal angiographic PCI results, residual disease at culprit lesion sites can cause major adverse cardiac events, but the relationship between post-PCI physiological assessment and long-term outcomes required investigation.
Does impaired post-PCI physiological assessment predict major adverse cardiac events in patients undergoing PCI?
Meta-Analysis
Does impaired post-PCI physiological assessment predict major adverse cardiac events in patients undergoing PCI?
Hazard Ratio: 2.32 (95% CI 1.71–3.16)
Impaired post-PCI physiological assessment is significantly associated with an increased risk of long-term adverse cardiac events, including death, MI, and target vessel revascularization.
Impaired post-PCI physiology identifies higher-risk patients; leaves open whether optimization improves outcomes in prospective trials.
Background Despite the optimal angiographic result of percutaneous coronary intervention (PCI), residual disease at the site of the culprit lesion can lead to major adverse cardiac events. Post-PCI physiological assessment can identify residual stenosis. This meta-analysis aims to investigate data of studies examining post-PCI physiological assessment in relation to long-term outcomes. Methods Studies were included in the meta-analysis after performing a systematic literature search on July 1, 2022. The primary end point was the incidence of major adverse cardiac events, vessel-orientated cardiac events, or target vessel failure. Results Low post-PCI fractional flow reserve, reported in 7 studies with fractional flow reserve cutoff values between 0.84 and 0.90, including 4017 patients, was associated with an increased rate of the primary end point (hazard ratio [HR], 2.06; 95% CI, 1.37-3.08). One study reported about impaired post-PCI instantaneous wave-free ratio with instantaneous wave-free ratio cutoff value of 0.95 in relation to major adverse cardiac events, showing a significant association (HR, 3.38; 95% CI, 0.99-11.6; P = .04). Low post-PCI quantitative flow ratio, reported in 3 studies with quantitative flow ratio cutoff value between 0.89 and 0.91, including 1181 patients, was associated with an increased rate of vessel-orientated cardiac events (HR, 3.01; 95% CI, 2.10-4.32). Combining data of all modalities, impaired physiological assessment showed an increased rate of the primary end point (HR, 2.32; 95% CI, 1.71-3.16) and secondary end points, including death (HR, 1.41; 95% CI, 1.04-1.89), myocardial infarction (HR, 2.70; 95% CI, 1.34-5.42) and target vessel revascularization (HR, 2.88; 95% CI, 1.91-4.35). Conclusions Impaired post-PCI physiological assessment is associated with increased adverse cardiac events and individual end points, including death, myocardial infarction, and target vessel revascularization. Therefore, prospective studies are awaited on whether physiology-based optimization of PCI results in better clinical outcomes.
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Griffioen et al. (2022) conducted a meta-analysis in Post-percutaneous coronary intervention (PCI). Impaired post-PCI physiological assessment vs. Normal/unimpaired post-PCI physiological assessment was evaluated on Incidence of major adverse cardiac events, vessel-orientated cardiac events, or target vessel failure (HR 2.32, 95% CI 1.71-3.16). Impaired post-PCI physiological assessment across all modalities was associated with an increased rate of major adverse cardiac events, vessel-orientated cardiac events, or target vessel failure (HR 2.32; 95% CI 1.71-3.16).
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