Intravascular Imaging Findings After PCI in Patients With Focal and Diffuse Coronary Artery Disease

• Published in: Journal of the American Heart Association Vol. 13; no. 5; p. e032605
• Main Authors: Ohashi, Hirofumi, Mizukami, Takuya, Sonck, Jeroen, Bouisset, Frederic, Ko, Brian, Nørgaard, Bjarne L., Mæng, Michael, Jensen, Jesper Møller, Sakai, Koshiro, Ando, Hirohiko, Amano, Tetsuya, Amabile, Nicolas, Ali, Ziad, De Bruyne, Bernard, Koo, Bon‐Kwon, Otake, Hiromasa, Collet, Carlos
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 05.03.2024; Wiley
• Subjects: Coronary Angiography - methods; coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - surgery; Coronary Vessels - diagnostic imaging; fractional flow reserve; Fractional Flow Reserve, Myocardial - physiology; Humans; optical coherence tomography; Original Research; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Predictive Value of Tests; Prospective Studies; pullback pressure gradient; Tomography, Optical Coherence - methods; Treatment Outcome; coronary artery disease; pullback pressure gradient; optical coherence tomography; fractional flow reserve
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.032605

Following percutaneous coronary intervention (PCI), optical coherence tomography provides prognosis information. The pullback pressure gradient is a novel index that discriminates focal from diffuse coronary artery disease based on fractional flow reserve pullbacks. We sought to investigate the association between coronary artery disease patterns, defined by coronary physiology, and optical coherence tomography after stent implantation in stable patients undergoing PCI. This multicenter, prospective, single-arm study was conducted in 5 countries (NCT03782688). Subjects underwent motorized fractional flow reserve pullbacks evaluation followed by optical coherence tomography-guided PCI. Post-PCI optical coherence tomography minimum stent area, stent expansion, and the presence of suboptimal findings such as incomplete stent apposition, stent edge dissection, and irregular tissue protrusion were compared between patients with focal versus diffuse disease. Overall, 102 patients (105 vessels) were included. Fractional flow reserve before PCI was 0.65±0.14, pullback pressure gradient was 0.66±0.14, and post-PCI fractional flow reserve was 0.88±0.06. The mean minimum stent area was 5.69±1.99 mm and was significantly larger in vessels with focal disease (6.18±2.12 mm versus 5.19±1.72 mm , =0.01). After PCI, incomplete stent apposition, stent edge dissection, and irregular tissue protrusion were observed in 27.6%, 10.5%, and 51.4% of the cases, respectively. Vessels with focal disease at baseline had a lower prevalence of incomplete stent apposition (11.3% versus 44.2%, =0.002) and more irregular tissue protrusion (69.8% versus 32.7%, <0.001). Baseline coronary pathophysiological patterns are associated with suboptimal imaging findings after PCI. Patients with focal disease had larger minimum stent area and a higher incidence of tissue protrusion, whereas stent malapposition was more frequent in patients with diffuse disease.