Impact of coronary physiological phenotypes on the immediate angiography-derived hemodynamic results of percutaneous coronary intervention

Background Angiography-based technologies can evaluate the physiological phenotypes of coronary artery disease (CAD) and the functional results of percutaneous coronary intervention (PCI), however, few studies have combined these to assess CAD pre- and post-PCI. Purpose We investigated the impact of physiological phenotypes of CAD on immediate post-PCI angiography-derived functional indices. Methods We analyzed 1004 vessels from three ongoing trials. Pre-PCI physiological phenotypes were characterized according to the angiography-derived pullback pressure gradient index (PPGi) as focal (≥0.66) or diffuse (<0.66). Local disease severity was assessed by instantaneous quantitative flow reserve (QFR) gradient per unit length (dQFR/ds) with a dQFR/ds≥0.025/mm, a "major" gradient. Post-PCI, epicardial and microvasculature functions were assessed using QFR and the index of microcirculatory resistance (angio-IMR), respectively. Results Pre-PCI, 327(35.81%) vessels had a PPGi<0.66, whilst 121 (13.25%) had a dQFR/ds<0.025 (Figure1, panel A). Post-PCI, a QFR<0.91 and IMR≥25 occurred in 247 (24.6%) and 310 (30.9%) vessels, respectively (Figure2, panel B). A post-PCI QFR<0.91 was associated with a lower PPGi (Odds ratio [OR]:1.31[1.17-1.47], p<0.001, Figure 1, panel C) but not a dQFR/ds (OR:0.99[0.96-1.02], p=0.453). A post-PCI IMR<25 was not associated with PPGi or dQFR/ds. Worsening in the IMR post-PCI was significantly associated with lower PPGi (1.31[1.16-1.48], p<0.001, Figure 1, panel D) and higher dQFR/ds (1.08[1.02-1.14], p=0.008, Figure 1, panel E) pre-PCI. Higher PPGi was associated with a higher odds ratio of achieving the optimal result (OR per 0.1 increase 1.25, [1.13-1.38], p<0.001, Figure 1, panel F). Multivariable analysis identified PPGi as an independent predictor of a post-PCI QFR≥0.91 and an optimal outcome (QFR≥0.91 and IMR<25, Figure2). Conclusion the phenotype of CAD pre-PCI can help predict functional outcome post-PCI, and therefore angiography-derived assessment has an important role in determining treatment strategy and outcome.Figure 1Figure 2