Key result
Physiology-guided incremental optimization achieves higher post-PCI FFR in focal versus diffuse CAD.
Why the study?
The impact of focal versus diffuse coronary artery disease patterns on a physiology-guided incremental optimisation strategy after stent implantation was unknown.
Does a physiology-guided incremental optimisation strategy (PIOS) improve post-PCI FFR differently in focal versus diffuse coronary artery disease?
RCT (n=114)
randomized
Does a physiology-guided incremental optimisation strategy (PIOS) improve post-PCI FFR differently in focal versus diffuse coronary artery disease?
Absolute Event Rate: 0.93% vs 0.83%
p-value: p=<0.001
While physiology-guided stent optimization is more frequently required in diffuse coronary disease, patients with focal disease achieve significantly higher post-PCI FFR when optimization is applied.
PIOS may be prioritized in focal CAD to maximize FFR gains; extends RCT evidence for pattern-specific physiology-guided optimization.
Assessing coronary physiology after stent implantation facilitates the optimisation of percutaneous coronary intervention (PCI). Coronary artery disease (CAD) patterns can be characterised by the pullback pressure gradient (PPG) index. The impact of focal vs. diffuse disease on physiology-guided incremental optimisation strategy (PIOS) is unknown. This is a sub-study of the TARGET-FFR randomized clinical trial (NCT03259815). The study protocol directed that optimisation be attempted for patients in the PIOS arm when post-PCI FFR was <0.90. Overall, 114 patients (n = 61 PIOS and 53 controls) with both pre-PCI fractional flow reserve (FFR) pullbacks and post-PCI FFR were included. A PPG ≥ 0.74 defined focal CAD. The PPG correlated significantly with post-PCI FFR (r = 0.43; 95% CI 0.26 to 0.57; p-value < 0.001) and normalised delta FFR (r = 0.49; 95% CI 0.34 to 0.62; p-value < 0.001). PIOS was more frequently applied to vessels with diffuse CAD (6% focal vs. 42% diffuse; p-value = 0.006). In patients randomized to PIOS, those with focal disease achieved higher post-PCI FFR than patients with diffuse CAD (0.93 ± 0.05 vs. 0.83 ± 0.07, p < 0.001). There was a significant interaction between CAD patterns and the randomisation arm for post-PCI FFR (p-value for interaction = 0.004). Physiology-guided stent optimisation was applied more frequently to vessels with diffuse disease; however, patients with focal CAD at baseline achieved higher post-PCI FFR.
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Ohashi et al. (2023) conducted an RCT in Coronary artery disease (CAD) (n=114). Physiology-guided incremental optimisation strategy (PIOS) vs. Control (standard care) was evaluated on Post-PCI FFR in patients randomized to PIOS (focal vs. diffuse CAD) (p=<0.001). In patients randomized to a physiology-guided incremental optimisation strategy, those with focal coronary artery disease achieved a higher post-PCI FFR than those with diffuse disease (0.93 vs 0.83; P<0.001).
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