Key result
In ischemic vessels treated by PCI, low PPG was associated with a higher risk of 2-year vessel-oriented composite outcome than high PPG (8.4% vs. 3.8%; HR 2.13, 95% CI 1.18-3.86).
Why the study?
The prognostic value of QFR-derived pullback pressure gradient (PPG) index to characterize atherosclerosis functional pattern in ischemia-causing vessels remains unclear.
Does percutaneous coronary intervention improve outcomes compared to conservative treatment in ischemia-causing vessels based on QFR-derived pullback pressure gradient (PPG) index?
Cohort (n=1,444)
Does percutaneous coronary intervention improve outcomes compared to conservative treatment in ischemia-causing vessels based on QFR-derived pullback pressure gradient (PPG) index?
QFR-derived PPG index can identify which physiologically ischemic vessels benefit from PCI (high PPG) versus those that have similar outcomes with conservative treatment (low PPG).
OBJECTIVE: To evaluate the prognostic implications of atherosclerosis functional pattern on ischemia-causing vessels received percutaneous coronary intervention (PCI) or conservative treatment. BACKGROUND: Quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) index is recently proposed to characterize atherosclerosis functional pattern, but its prognostic value remains unclear. METHODS: QFR-derived PPG index was retrospectively calculated in patients from the PANDA III trial. Vessels with low or high PPG treated by PCI or not were compared for the risk of 2-year vessel-oriented composite outcome (VOCO), which was a composite of vessel-related ischemia-driven revascularization, vessel-related myocardial infarction, or cardiac death. RESULTS: A total of 1444 vessels were included while 94 (6.5%) VOCOs occurred within 2 years. Among physiologically ischemic vessels (QFR ≤ 0.80) treated by PCI, those with low PPG acquired higher VOCO risk than those with high PPG (8.4% vs. 3.8%; adjusted hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.18 to 3.86), and a similar VOCO risk (8.4% vs. 7.8%; adjusted HR 1.11, 95%CI 0.70-1.78) compared to those treated by conservatively. After multiple adjustment, PPG index was an independent predictor for VOCO (HR 1.30, 95% CI 1.05-1.62). The addition of PPG to the model of clinical risk factors substantially improved the predictions of VOCO (C-index 0.67 vs. 0.62, net reclassification index 0.42). CONCLUSIONS: PCI treatment was associated with improved outcomes in vessels with high PPG, but not for those with low PPG, which acquired similar risk of VOCO compared to vessels treated conservatively. QFR-derived PPG might assist the treatment strategy selection in ischemia-causing vessels.
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Dai et al. (2021) conducted a cohort in Coronary artery disease (n=1,444). Low pullback pressure gradient (PPG) vs. High pullback pressure gradient (PPG) was evaluated on 2-year vessel-oriented composite outcome (VOCO) (HR 2.13, 95% CI 1.18-3.86). In ischemic vessels treated by PCI, low PPG was associated with a higher risk of 2-year vessel-oriented composite outcome than high PPG (8.4% vs. 3.8%; HR 2.13, 95% CI 1.18-3.86).
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