This study sought to evaluate the prognostic value of post–percutaneous coronary intervention (PCI) distal coronary pressure to aortic pressure ratio (Pd/Pa) in predicting long-term clinical outcomes and to determine whether Pd/Pa combined with fractional flow reserve (FFR) post-intervention provides additional prognostic information superior to either marker alone.
Background
Post-PCI FFR has been shown to be a predictor of long-term outcomes in numerous studies. The role of post-PCI resting Pd/Pa has not been previously studied in this setting.
Methods
Consecutive patients undergoing PCI who had pre- and post-PCI Pd/Pa and FFR were followed for major adverse cardiovascular events (MACE) including death, myocardial infarction, and target vessel revascularization.
Results
A total of 574 patients were followed for 30 months (25th to 75th percentile 18 to 46 months). Using receiver-operating characteristic curve analysis post-stenting FFR cutoff of ≤0.86 had the best predictive accuracy of MACE (17% vs. 23%; log-rank p = 0.02), whereas post-stenting Pd/Pa ≤0.96 was the best predictor of MACE (15% vs. 24%; log rank p = 0.0006). There was a significant interaction between post-PCI Pd/Pa and FFR on MACE risk such that patients with Pd/Pa ≤0.96 and FFR ≤0.86 had the highest event rate (25%), whereas those with Pd/Pa >0.96 and FFR >0.86 had the lowest event rate (15%), which was not different from patients with Pd/Pa >0.96 and FFR ≤0.86 (17%). In a fully adjusted Cox regression analysis, Pd/Pa was an independent predictor of MACE (hazard ratio: 2.07; 95% confidence interval: 1.3 to 3.3; p = 0.002).
Conclusions
Post-PCI resting Pd/Pa is a powerful prognostic tool for MACE prediction. It adds complementary and incremental risk stratification over established factors including post-PCI FFR.
Central Illustration
Key Words
FFR
Pd/Pa
post-PCI hemodynamics
prognosis
Abbreviations and Acronyms
ACS
acute coronary syndrome
CI
confidence interval
FFR
fractional flow reserve
HR
hazard ratio
iFR
instantaneous wave-free ratio
LAD
left anterior descending artery
MACE
major adverse cardiovascular events
MI
myocardial infarction
PCI
percutaneous coronary intervention
Pd/Pa
distal coronary pressure to aortic pressure ratio
ROC
receiver-operating characteristic curve
TVF
target vessel failure
TVR
target vessel revascularization
VA
Veterans Affairs
Cited by (0)
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.