1
|
Zhang J, Hwang D, Yang S, Hu X, Lee JM, Nam CW, Shin ES, Doh JH, Hoshino M, Hamaya R, Kanaji Y, Murai T, Zhang JJ, Ye F, Li X, Ge Z, Chen SL, Kakuta T, Wang J, Koo BK. Angiographic Findings and Post-Percutaneous Coronary Intervention Fractional Flow Reserve. JAMA Netw Open 2024; 7:e2418072. [PMID: 38904958 PMCID: PMC11193130 DOI: 10.1001/jamanetworkopen.2024.18072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/22/2024] [Indexed: 06/22/2024] Open
Abstract
Importance The associations between angiographic findings and post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) and their clinical relevance according to residual functional disease burden have not been thoroughly investigated. Objectives To evaluate the association of angiographic and physiologic parameters according to residual functional disease burden after drug-eluting stent implantation. Design, Setting, and Participants This cohort study population was from the International Post-PCI FFR registry, which incorporated 4 registries from Korea, China, and Japan. Patients who underwent angiographically successful second-generation drug-eluting stent implantation and post-PCI FFR measurement were included in the analysis. The patients were divided into 3 groups according to the residual disease burden (post-PCI FFR ≤0.80 [residual ischemia], 0.81-0.86 [suboptimal], and >0.86 [optimal]). The data were collected from August 23, 2018, to June 11, 2019, and the current analysis was performed from January 11, 2022, to October 7, 2023. Exposures Angiographic parameters and post-PCI FFR. Main Outcomes and Measures The primary outcome was target vessel failure (TVF), defined as a composite of cardiac death, target vessel-related myocardial infarction, and target vessel revascularization (TVR) at 2 years. Results In this cohort of 2147 patients, the mean (SD) age was 64.3 (10.0) years, and 1644 patients (76.6%) were men. Based on the post-PCI physiologic status, 269 patients (12.5%) had residual ischemia, 551 (25.7%) had suboptimal results, and 1327 (61.8%) had optimal results. Angiographic parameters had poor correlations with post-PCI FFR (r < 0.20). Post-PCI FFR was isolated from all angiographic parameters in the unsupervised hierarchical cluster analysis. Post-PCI FFR was associated with the occurrence of TVF (adjusted hazard ratio [AHR] per post-PCI FFR 0.01 increase, 0.94 [95% CI, 0.92-0.97]; P < .001), but angiographic parameters were not. The residual ischemia group had a significantly higher rate of TVF than the suboptimal group (AHR, 1.75 [95% CI, 1.08-2.83]; P = .02) and the optimal group (AHR, 2.94 [95% CI, 1.82-4.73]; P < .001). The TVR in the residual ischemia group was predominantly associated with TVR in the nonstented segment (14 [53.8%]), unlike the other 2 groups (3 [10.0%] in the suboptimal group and 13 [30.2%] in the optimal group). Conclusions and Relevance In this cohort study of the International Post-PCI FFR registry, a low degree of associations were observed between angiographic and physiologic parameters after PCI. Post-PCI FFR, unlike angiographic parameters, was associated with clinical events and the distribution of clinical events. The current study supports the use of post-PCI FFR as a procedural quality metric and further prospective study is warranted.
Collapse
Affiliation(s)
- Jinlong Zhang
- Department of Cardiology, Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Xinyang Hu
- Department of Cardiology, Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaobo Li
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Jian’an Wang
- Department of Cardiology, Second Affiliated Hospital of Zhejiang University School of Medicine, State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
2
|
Ahn JM, Kang DY, Kim JH, Choi Y, Kim H, Lee J, Park DW, Park SJ. Prognostic Value of Poststenting Fractional Flow Reserve After Imaging-Guided Optimal Stenting. JACC Cardiovasc Interv 2024; 17:907-916. [PMID: 38599694 DOI: 10.1016/j.jcin.2024.01.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 12/29/2023] [Accepted: 01/30/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Prognostic value of poststenting fractional flow reserve (FFR) remains uncertain in patients undergoing an imaging-guided optimal stenting strategy. OBJECTIVES The authors evaluated the prognostic value of poststenting FFR according to the intracoronary imaging-guided lesion preparation, stent sizing, and postdilation (iPSP) strategy to optimize stent outcomes. METHODS Poststenting FFR assessment was performed in 1,108 lesions in 1,005 patients from the IRIS-FFR registry. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization at 5 years. RESULTS At the index procedure, 326 lesions (29.4%) were treated using all 3 parts of the iPSP strategy. In the overall population, poststenting FFR was significantly associated with the risk of TVF at 5 years (per 0.01 increase of FFR, adjusted HR [aHR]: 0.94; 95% CI: 0.90-0.98; P = 0.004). Significant interaction was detected between poststenting FFR and the iPSP strategy on the risk of TVF at 5 years (P = 0.045 for interaction). In the iPSP group, poststenting FFR was not associated with the risk of TVF at 5 years (per 0.01 increase of FFR, aHR: 1.00; 95% CI: 0.96-1.05; P = 0.95), whereas a significant association between poststenting FFR and TVF at 5 years was observed in the no iPSP group (per 0.01 increase of FFR, aHR: 0.94; 95% CI: 0.90-0.99; P = 0.009). CONCLUSIONS Poststenting FFR showed a significant association with cardiac events. However, its prognostic value appeared to be limited after the application of an imaging-guided optimal stenting strategy.
Collapse
Affiliation(s)
- Jung-Min Ahn
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Do-Yoon Kang
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yeonwoo Choi
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hoyun Kim
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinho Lee
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
3
|
Biscaglia S, Verardi FM, Erriquez A, Colaiori I, Cocco M, Cantone A, Pompei G, Marrone A, Caglioni S, Tumscitz C, Penzo C, Manfrini M, Leone AM, Versaci F, Campo G. Coronary Physiology Guidance vs Conventional Angiography for Optimization of Percutaneous Coronary Intervention: The AQVA-II Trial. JACC Cardiovasc Interv 2024; 17:277-287. [PMID: 37902150 DOI: 10.1016/j.jcin.2023.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The debate surrounding the efficacy of coronary physiological guidance compared with conventional angiography in achieving optimal post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) values persists. OBJECTIVES The primary aim of this study was to demonstrate the superiority of physiology-guided PCI, using either angiography or microcatheter-derived FFR, over conventional angiography-based PCI in complex high-risk indicated procedures (CHIPs). The secondary aim was to establish the noninferiority of angiography-derived FFR guidance compared with microcatheter-derived FFR guidance. METHODS Patients with obstructive coronary lesions and meeting CHIP criteria were randomized 2:1 to receive undergo physiology- or angiography-based PCI. Those assigned to the former were randomly allocated to angiography- or microcatheter-derived FFR guidance. CHIP criteria were long lesion (>28 mm), tandem lesions, severe calcifications, severe tortuosity, true bifurcation, in-stent restenosis, and left main stem disease. The primary outcome was invasive post-PCI FFR value. The optimal post-PCI FFR value was defined as >0.86. RESULTS A total of 305 patients (331 study vessels) were enrolled in the study (101 undergoing conventional angiography-based PCI and 204 physiology-based PCI). Optimal post-PCI FFR values were more frequent in the physiology-based PCI group compared with the conventional angiography-based PCI group (77% vs 54%; absolute difference 23%, relative difference 30%; P < 0.0001). The occurrence of the primary outcome did not differ between the 2 physiology-based PCI subgroups, demonstrating the noninferiority of angiography- vs microcatheter-derived FFR (P < 0.01). CONCLUSIONS In CHIP patients, procedural planning and guidance on the basis of physiology (through either angiography- or microcatheter-derived FFR) are superior to conventional angiography for achieving optimal post-PCI FFR values. (Physiology Optimized Versus Angio-Guided PCI [AQVA-II]; NCT05658952).
Collapse
Affiliation(s)
- Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy.
| | | | - Andrea Erriquez
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Iginio Colaiori
- UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy
| | - Marta Cocco
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Anna Cantone
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Graziella Pompei
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Andrea Marrone
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Serena Caglioni
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Carlo Penzo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Marco Manfrini
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Antonio Maria Leone
- Center of Excellence in Cardiovascular Sciences, Ospedale Fatebenefratelli Isola Tiberina, Gemelli Isola, Rome, Italy
| | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| |
Collapse
|
4
|
Shan Y, Lin M, Gu F, Ying S, Bao X, Zhu Q, Tao Y, Chen Z, Li D, Zhang W, Fu G, Wang M. Association between fasting stress hyperglycemia ratio and contrast-induced acute kidney injury in coronary angiography patients: a cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1300373. [PMID: 38155953 PMCID: PMC10753820 DOI: 10.3389/fendo.2023.1300373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Aims Stress hyperglycemia ratio (SHR), an emerging indicator of critical illness, exhibits a significant association with adverse cardiovascular outcomes. The primary aim of this research endeavor is to evaluate the association between fasting SHR and contrast-induced acute kidney injury (CI-AKI). Methods This cross-sectional study comprised 3,137 patients who underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI). The calculation of fasting SHR involved dividing the admission fasting blood glucose by the estimated mean glucose obtained from glycosylated hemoglobin. CI-AKI was assessed based on elevated serum creatinine (Scr) levels. To investigate the relationship between fasting SHR and the proportion of SCr elevation, piecewise linear regression analysis was conducted. Modified Poisson's regression analysis was implemented to evaluate the correlation between fasting SHR and CI-AKI. Subgroup analysis and sensitivity analysis were conducted to explore result stability. Results Among the total population, 482 (15.4%) patients experienced CI-AKI. Piecewise linear regression analysis revealed significant associations between the proportion of SCr elevation and fasting SHR on both sides (≤ 0.8 and > 0.8) [β = -12.651, 95% CI (-23.281 to -2.022), P = 0.020; β = 8.274, 95% CI (4.176 to 12.372), P < 0.001]. The Modified Poisson's regression analysis demonstrated a statistically significant correlation between both the lowest and highest levels of fasting SHR and an increased incidence of CI-AKI [(SHR < 0.7 vs. 0.7 ≤ SHR < 0.9) β = 1.828, 95% CI (1.345 to 2.486), P < 0.001; (SHR ≥ 1.3 vs. 0.7 ≤ SHR < 0.9) β = 2.896, 95% CI (2.087 to 4.019), P < 0.001], which was further validated through subgroup and sensitivity analyses. Conclusion In populations undergoing CAG or PCI, both lowest and highest levels of fasting SHR were significantly associated with an increased occurrence of CI-AKI.
Collapse
Affiliation(s)
- Yu Shan
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Maoning Lin
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Fangfang Gu
- Department of Cardiology, The Affiliated Huzhou Hospital (Huzhou Central Hospital), College of Medicine, Zhejiang University, Huzhou, Zhejiang, China
| | - Shuxin Ying
- Department of Endocrinology and Metabolism, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoyi Bao
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Qiongjun Zhu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Yecheng Tao
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Zhezhe Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Duanbin Li
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Wenbin Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Min Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| |
Collapse
|
5
|
Hamaya R, Goto S, Hwang D, Zhang J, Yang S, Lee JM, Hoshino M, Nam CW, Shin ES, Doh JH, Chen SL, Toth GG, Piroth Z, Hakeem A, Uretsky BF, Hokama Y, Tanaka N, Lim HS, Ito T, Matsuo A, Azzalini L, Leesar MA, Collet C, Koo BK, De Bruyne B, Kakuta T. Machine-learning-based prediction of fractional flow reserve after percutaneous coronary intervention. Atherosclerosis 2023; 383:117310. [PMID: 37797507 DOI: 10.1016/j.atherosclerosis.2023.117310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) reflects residual atherosclerotic burden and is associated with future events. How much post-PCI FFR can be predicted based on baseline basic information and the clinical relevance have not been investigated. METHODS We compiled a multicenter registry of patients undergoing pre- and post-PCI FFR. Machine-learning (ML) algorithms were designed to predict post-PCI FFR levels from baseline demographics, quantitative coronary angiography, and pre-PCI FFR. FFR deviation was defined as actual minus ML-predicted post-PCI FFR levels, and its association with incident target vessel failure (TVF) was evaluated. RESULTS Median (IQR) pre- and post-PCI FFR values were 0.71 (0.61, 0.77) and 0.88 (0.84, 0.93), respectively. The Spearman correlation coefficient of the actual and predicted post-PCI FFR was 0.54 (95% CI: 0.52, 0.57). FFR deviation was non-linearly associated with incident TVF (HR [95% CI] with Q3 as reference: 1.65 [1.14, 2.39] in Q1, 1.42 [0.98, 2.08] in Q2, 0.81 [0.53, 1.26] in Q4, and 1.04 [0.69, 1.56] in Q5). A model with polynomial function of continuous FFR deviation indicated increasing TVF risk for FFR deviation ≤0 but plateau risk with FFR deviation >0. CONCLUSIONS An ML-based algorithm using baseline data moderately predicted post-PCI FFR. The deviation of post-PCI FFR from the predicted value was associated with higher vessel-oriented event.
Collapse
Affiliation(s)
- Rikuta Hamaya
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Shinichi Goto
- One Brave Idea and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Seoul, Republic of Korea
| | - Masahiro Hoshino
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Gabor G Toth
- University Heart Centre Graz, Medical University, Graz, Austria
| | - Zsolt Piroth
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - Abdul Hakeem
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Barry F Uretsky
- Central Arkansas VA Health System/University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, South Korea
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akiko Matsuo
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Massoud A Leesar
- Division of Cardiovascular Diseases, University of Cincinnati, Cincinnati, OH, USA
| | | | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Aalst, Belgium; Department of Cardiology, University of Lausanne, Switzerland
| | - Tsunekazu Kakuta
- Tsuchiura Kyodo General Hospital, Department of Cardiology, Tsuchiura City, Japan.
| |
Collapse
|
6
|
Liu W, Cai H, Zheng Y, Wen Y, Chen S, Xie X, Zeng H, Zhu H, Ni Z, Pei F, Cao J, Cao G. Predictive Value of Post-Percutaneous Coronary Intervention Quantitative Flow Ratio for Vessel-Oriented Composite Endpoint. J Interv Cardiol 2023; 2023:2438347. [PMID: 37720628 PMCID: PMC10505082 DOI: 10.1155/2023/2438347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 08/08/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
At present, there is a lack of indicators, which can accurately predict the post-percutaneous coronary intervention (post-PCI) vessel-oriented composite endpoint (VOCE). Recent studies showed that the post-PCI quantitative flow ratio (QFR) can predict post-PCI VOCE. PubMed, Embase, and Cochrane were searched from inception to March 27, 2022, and the cohort studies about that the post-PCI QFR predicts post-PCI VOCE were screened. Meta-analysis was performed, including 6 studies involving 4518 target vessels. The results of the studies included in this meta-analysis all showed that low post-PCI QFR was an independent risk factor for post-PCI VOCE after adjusting for other factors, HR (95% CI) ranging from 2.718 (1.347-5.486) to 6.53 (2.70-15.8). Our meta-analysis showed that the risk of post-PCI VOCE was significantly higher in the lower post-PCI QFR group than in the higher post-PCI QFR group (HR: 4.14, 95% CI: 3.00-5.70, P < 0.001, I2 = 27.9%). Post-PCI QFR has a good predictive value for post-PCI VOCE. Trial Registration. This trial is registered with CRD42022322001.
Collapse
Affiliation(s)
- Weibin Liu
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou 341000, China
| | - Huaxiu Cai
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou 341000, China
| | - Yin Zheng
- Gannan Medical University, Ganzhou 341000, China
| | - Yongkang Wen
- Gannan Medical University, Ganzhou 341000, China
| | - Sicheng Chen
- Gannan Medical University, Ganzhou 341000, China
| | - Xiuying Xie
- Department of General Practice, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Huan Zeng
- Department of Radiology and Imaging, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Hengqing Zhu
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Zhonghan Ni
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Fang Pei
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Jun Cao
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Gang Cao
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| |
Collapse
|
7
|
Ilic I, Timcic S, Milosevic M, Boskovic S, Odanovic N, Furtula M, Dobric M, Aleksandric S, Otasevic P. The imPAct of Trimetazidine on MicrOcirculation after Stenting for stable coronary artery disease (PATMOS study). Front Cardiovasc Med 2023; 10:1112198. [PMID: 37456821 PMCID: PMC10348888 DOI: 10.3389/fcvm.2023.1112198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
Background Myocardial ischemia is caused by epicardial coronary artery stenosis or atherosclerotic disease affecting microcirculation. Trimetazidine (TMZ), promotes glucose oxidation which optimizes cellular energy processes in ischemic conditions. Small studies demonstrated protective effects of TMZ in terms of reducing myocardial injury after percutaneous coronary intervention (PCI), its effect on microcirculation using contemporary investigative methods has not been studied. The aim of the study was to examine effects of trimetazidine, given before elective PCI, on microcirculation using invasively measured index of microcirculatory resistance (IMR). Methods This was prospective, single blinded, randomized study performed in a single university hospital. It included consecutive patients with an indication for PCI of a single, de novo, native coronary artery lesion. Patients were randomly assigned to receive either TMZ plus standard therapy (TMZ group) or just standard therapy. Coronary physiology indices fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were measured before and after PCI using coronary pressure wire. Results We randomized 71 patients with similar clinical characteristics and risk profile, previous medications and coronary angiograms. Patientshad similar values of Pd/Pa, FFR and CFR prior to PCI procedure. After PCI, FFR values were higher in TMZ group, while IMR values were lower in this group respectively (FFR TMZ + 0.89 ± 0.05 vs. TMZ - 0.85 ± 0.06, p = 0.007; CFR TMZ + 2.1 ± 0.8 vs. TMZ- 2.3 ± 1.3, p = 0.469; IMR TMZ + 18 ± 9 vs. TMZ- 24 ± 12, p = 0.028). In two-way repeated measures ANOVA PCI was associated with change in FFR values (TMZ p = 0.050; PCI p < 0.001; p for interaction 0.577) and TMZ with change in IMR values (TMZ p = 0.034, PCI p = 0.129, p for interaction 0.344). Conclusion Adding trimetazidine on top of medical treatment prior to elective PCI reduces microvascular dysfunction by lowering postprocedural IMR values when compared to standard therapy alone.
Collapse
Affiliation(s)
- Ivan Ilic
- Cardiology Clinic, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Timcic
- Cardiology Clinic, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Maja Milosevic
- Cardiology Clinic, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Srdjan Boskovic
- Cardiology Clinic, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Natalija Odanovic
- Cardiology Clinic, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Matija Furtula
- Cardiology Clinic, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Milan Dobric
- Cardiology Clinic, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Srdjan Aleksandric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Petar Otasevic
- Cardiology Clinic, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
8
|
Yong D, Minjie C, Yujie Z, Jianli W, Ze L, Pengfei L, Xiangling L, Xiujian L, Javier DS. Diagnostic performance of IVUS-FFR analysis based on generative adversarial network and bifurcation fractal law for assessing myocardial ischemia. Front Cardiovasc Med 2023; 10:1155969. [PMID: 37020517 PMCID: PMC10067879 DOI: 10.3389/fcvm.2023.1155969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/20/2023] [Indexed: 03/22/2023] Open
Abstract
BackgroundIVUS-based virtual FFR (IVUS-FFR) can provide additional functional assessment information to IVUS imaging for the diagnosis of coronary stenosis. IVUS image segmentation and side branch blood flow can affect the accuracy of virtual FFR. The purpose of this study was to evaluate the diagnostic performance of an IVUS-FFR analysis based on generative adversarial networks and bifurcation fractal law, using invasive FFR as a reference.MethodIn this study, a total of 108 vessels were retrospectively collected from 87 patients who underwent IVUS and invasive FFR. IVUS-FFR was performed by analysts who were blinded to invasive FFR. We evaluated the diagnostic performance and computation time of IVUS-FFR, and compared it with that of the FFR-branch (considering side branch blood flow by manually extending the side branch from the bifurcation ostia). We also compared the effects of three bifurcation fractal laws on the accuracy of IVUS-FFR.ResultThe diagnostic accuracy, sensitivity, and specificity for IVUS-FFR to identify invasive FFR≤0.80 were 90.7% (95% CI, 83.6–95.5), 89.7% (95% CI, 78.8–96.1), 92.0% (95% CI, 80.8–97.8), respectively. A good correlation and agreement between IVUS-FFR and invasive FFR were observed. And the average computation time of IVUS-FFR was shorter than that of FFR-branch. In addition to this, we also observe that the HK model is the most accurate among the three bifurcation fractal laws.ConclusionOur proposed IVUS-FFR analysis correlates and agrees well with invasive FFR and shows good diagnostic performance. Compared with FFR-branch, IVUS-FFR has the same level of diagnostic performance with significantly lower computation time.
Collapse
Affiliation(s)
- Dong Yong
- Department of Cardiology, the 7th People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Chen Minjie
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, China
| | - Zhao Yujie
- Department of Cardiology, the 7th People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Wang Jianli
- Department of Cardiology, the 7th People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Liu Ze
- Department of Cardiology, the 7th People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Li Pengfei
- Department of Cardiology, the 7th People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Lai Xiangling
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, China
| | - Liu Xiujian
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, China
- Correspondence: Xiujian Liu
| | - Del Ser Javier
- TECNALIA, Basque Research & Technology Alliance (BRTA), Derio, Spain
- University of the Basque Country (UPV/EHU), Bilbao, Spain
| |
Collapse
|
9
|
Biscaglia S, Verardi FM, Tebaldi M, Guiducci V, Caglioni S, Campana R, Scala A, Marrone A, Pompei G, Marchini F, Scancarello D, Pignatelli G, D'Amore SM, Colaiori I, Demola P, Di Serafino L, Tumscitz C, Penzo C, Erriquez A, Manfrini M, Campo G. QFR-Based Virtual PCI or Conventional Angiography to Guide PCI: The AQVA Trial. JACC Cardiovasc Interv 2023; 16:783-794. [PMID: 36898939 DOI: 10.1016/j.jcin.2022.10.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 03/12/2023]
Abstract
BACKGROUND Post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) values ≥0.90 are associated with a low incidence of adverse events. OBJECTIVES The AQVA (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR) trial aims to test whether a QFR-based virtual percutaneous coronary intervention (PCI) is superior to a conventional angiography-based PCI at obtaining optimal post-PCI QFR results. METHODS The AQVA trial is an investigator-initiated, randomized, controlled, parallel-group clinical trial. Three hundred patients (356 study vessels) undergoing PCI were randomized 1:1 to receive either QFR-based virtual PCI or angiography-based PCI (standard of care). The primary outcome was the rate of study vessels with a suboptimal post-PCI QFR value, which was defined as <0.90. Secondary outcomes were procedure duration, stent length/lesion, and stent number/patient. RESULTS Overall, 38 (10.7%) study vessels missed the prespecified optimal post-PCI QFR target. The primary outcome occurred significantly more frequently in the angiography-based group (n = 26, 15.1%) compared with the QFR-based virtual PCI group (n = 12 [6.6%]; absolute difference = 8.5%; relative difference = 57%; P = 0.009). The main cause of a suboptimal result in the angiography-based group is the underestimation of a diseased segment outside the stented one. There were no significant differences among secondary endpoints, although stent length/lesion and stent number/patient were numerically lower in the virtual PCI group (P = 0.06 and P = 0.08, respectively), whereas procedure length was higher in the virtual PCI group (P = 0.06). CONCLUSIONS The AQVA trial demonstrated the superiority of QFR-based virtual PCI over angiography-based PCI with regard to post-PCI optimal physiological results. Future larger randomized clinical trials that demonstrate the superiority of this approach in terms of clinical outcomes are warranted. (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR [AQVA]; NCT04664140).
Collapse
Affiliation(s)
- Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy.
| | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Vincenzo Guiducci
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Serena Caglioni
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Roberta Campana
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Antonella Scala
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Andrea Marrone
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Graziella Pompei
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Federico Marchini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Davide Scancarello
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Gianluca Pignatelli
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Sergio Musto D'Amore
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Iginio Colaiori
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Pierluigi Demola
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Di Serafino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Carlo Penzo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Andrea Erriquez
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Marco Manfrini
- Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Cotignola, Ravenna, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| |
Collapse
|
10
|
Csanádi B, Ferenci T, Fülöp G, Piróth Z. Clinical Implications of Fractional Flow Reserve Measured Immediately After Percutaneous Coronary Intervention. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07437-0. [PMID: 36821060 DOI: 10.1007/s10557-023-07437-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The purpose of the present study was to find the independent predictors of Fractional Flow Reserve (FFR) measured immediately after percutaneous coronary intervention with drug-eluting stent implantation (post-PCI FFR) and investigate if applying vessel-specific post-PCI FFR cut-off values to predict target vessel failure (TVF), a composite of cardiac death (CD), non-fatal myocardial infarction (MI) and target vessel revascularization (TVR), or a composite of CD and MI ameliorated its predictive power. METHODS Consecutive patients with post-PCI FFR measurement at our center between 2009 and 2021 were included in this analysis. RESULTS A total of 434 patients with 500 vessels were included. Median pre-PCI FFR was 0.72 with no difference between LAD and non-LAD vessels. Median post-PCI FFR was 0.87. LAD location, male gender, smaller stent diameter, and lower pre-PCI FFR proved to be significant predictors of a lower post-PCI FFR. On a vessel-level, post-PCI FFR, stent length, and diabetes mellitus proved to be significant predictors of TVF and the composite of CD and MI. The best post-PCI FFR cut-off to predict TVF or a composite of CD and MI was 0.83 in the LAD and 0.91 in non-LAD vessels. CONCLUSION LAD location is a predictor of a lower post-PCI FFR. Post-PCI FFR is an independent predictor of TVF as well as of the composite of CD and MI. No uniform target post-PCI FFR value exists; different cut-off values may have to be applied in LAD as opposed to non-LAD vessels.
Collapse
Affiliation(s)
- Bettina Csanádi
- Gottsegen National Cardiovascular Center, 29 Haller Str., 1096, Budapest, Hungary
| | - Tamás Ferenci
- Physiological Controls Group, John von Neumann Faculty of Informatics, Óbuda University, Budapest, Hungary
| | - Gábor Fülöp
- Gottsegen National Cardiovascular Center, 29 Haller Str., 1096, Budapest, Hungary
| | - Zsolt Piróth
- Gottsegen National Cardiovascular Center, 29 Haller Str., 1096, Budapest, Hungary.
| |
Collapse
|
11
|
Bashar H, Matetić A, Curzen N, Mamas MA. Impact of extracardiac vascular disease on outcomes of 1.4 million patients undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2022; 100:737-746. [PMID: 36129816 PMCID: PMC9826290 DOI: 10.1002/ccd.30404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/24/2022] [Accepted: 09/07/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Extracardiac vascular disease (ECVD) is increasingly recognized as a cardiovascular risk factor, but its association with outcomes after percutaneous coronary intervention (PCI) has not been well characterized. METHODS Using the National Inpatient Sample database, all patients undergoing PCI between October 2015 and December 2018 were stratified by the presence and organ-specific extent of extracardiac vascular comorbidity (cerebrovascular disease (CeVD), renovascular, aortic and peripheral arterial disease (PAD)). Primary outcome was all-cause mortality and secondary outcomes were (a) major adverse cardiovascular and cerebrovascular events (MACCE), (b) acute ischemic stroke and (c) major bleeding. Multivariable logistic regression was used to determine the adjusted odds ratios (aOR) and 95% confidence interval (95% CI). RESULTS Of a total of 1,403,505 patients undergoing PCI during the study period, 199,470 (14.2%) had ECVD. Patients with ECVD were older (median of 72 years vs. 70 years, p < 0.001) and had higher comorbidity burden that their counterparts. All cause-mortality was 22% higher in patients with any ECVD compared to those without ECVD. PAD patients had the highest odds of all-cause mortality (aOR 1.48, 95% CI 1.40-1.56), followed by those with CeVD (aOR 1.15, 95% CI 1.10-1.19). Patients with extracardiac disease had increased odds of MACCE, ischemic stroke and bleeding, irrespective of the nature or extent (p < 0.05), compared to patients without ECVD. CONCLUSION ECVD is associated with worse outcomes in patients undergoing PCI including significantly higher rates of death and stroke. These data should inform our shared decision-making process with our patients.
Collapse
Affiliation(s)
- Hussein Bashar
- Faculty of MedicineUniversity of SouthamptonSouthamptonUK,Coronary Research GroupUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health SciencesKeele UniversityKeeleUK
| | - Andrija Matetić
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health SciencesKeele UniversityKeeleUK,Department of CardiologyUniversity Hospital of SplitSplitCroatia
| | - Nick Curzen
- Faculty of MedicineUniversity of SouthamptonSouthamptonUK,Coronary Research GroupUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health SciencesKeele UniversityKeeleUK
| |
Collapse
|
12
|
Ploscaru V, Popa-Fotea NM, Calmac L, Itu LM, Mihai C, Bataila V, Dragoescu B, Puiu A, Cojocaru C, Costin MA, Scafa-Udriste A. Artificial intelligence and cloud based platform for fully automated PCI guidance from coronary angiography-study protocol. PLoS One 2022; 17:e0274296. [PMID: 36084034 PMCID: PMC9462679 DOI: 10.1371/journal.pone.0274296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Ischemic heart disease represent a heavy burden for the medical systems irrespective of the methods used for diagnosis and treatment of such patients in the daily medical routine. The present paper depicts the protocol of a study whose main aim is to develop, implement and test an artificial intelligence algorithm and cloud based platform for fully automated PCI guidance using coronary angiography images. We propose the utilisation of multiple artificial intelligence based models to produce three-dimensional coronary anatomy reconstruction and assess function- post-PCI FFR computation- for developing an extensive report describing and motivating the optimal PCI strategy selection. All the relevant artificial intelligence model outputs (anatomical and functional assessment–pre- and post-PCI) are presented to the clinician via a cloud platform, who can then take the utmost treatment decision. The physician will be provided with multiple scenarios and treatment possibilities for the same case allowing a real-time evaluation of the most appropriate PCI strategy planning and follow-up. The artificial intelligence algorithms and cloud based PCI selection workflow will be verified and validated in a pilot clinical study including subjects prospectively to compare the artificial intelligence services and results against annotations and invasive measurements.
Collapse
Affiliation(s)
- Vlad Ploscaru
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Nicoleta-Monica Popa-Fotea
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
- Department Cardio-Thoracic 4, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- * E-mail:
| | - Lucian Calmac
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Lucian Mihai Itu
- Department of Image Fusion and Analytics, Siemens SRL, Brasov, Romania
- Department of Automation and Applied Informatics, Transylvania University of Brasov, Brasov, Romania
| | - Cosmin Mihai
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Vlad Bataila
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Bogdan Dragoescu
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Andrei Puiu
- Department of Image Fusion and Analytics, Siemens SRL, Brasov, Romania
- Department of Automation and Applied Informatics, Transylvania University of Brasov, Brasov, Romania
| | - Cosmin Cojocaru
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
- Department Cardio-Thoracic 4, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | | | - Alexandru Scafa-Udriste
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
- Department Cardio-Thoracic 4, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| |
Collapse
|
13
|
Hwang D, Koo BK, Zhang J, Park J, Yang S, Kim M, Yun JP, Lee JM, Nam CW, Shin ES, Doh JH, Chen SL, Kakuta T, Toth GG, Piroth Z, Johnson NP, Pijls NHJ, Hakeem A, Uretsky BF, Hokama Y, Tanaka N, Lim HS, Ito T, Matsuo A, Azzalini L, Leesar MA, Neleman T, van Mieghem NM, Diletti R, Daemen J, Collison D, Collet C, De Bruyne B. Prognostic Implications of Fractional Flow Reserve After Coronary Stenting: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2232842. [PMID: 36136329 PMCID: PMC9500557 DOI: 10.1001/jamanetworkopen.2022.32842] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is generally considered to reflect residual disease. Yet the clinical relevance of post-PCI FFR after drug-eluting stent (DES) implantation remains unclear. OBJECTIVE To evaluate the clinical relevance of post-PCI FFR measurement after DES implantation. DATA SOURCES MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant published articles from inception to June 18, 2022. STUDY SELECTION Published articles that reported post-PCI FFR after DES implantation and its association with clinical outcomes were included. DATA EXTRACTION AND SYNTHESIS Patient-level data were collected from the corresponding authors of 17 cohorts using a standardized spreadsheet. Meta-estimates for primary and secondary outcomes were analyzed per patient and using mixed-effects Cox proportional hazard regression with registry identifiers included as a random effect. All processes followed the Preferred Reporting Items for Systematic Review and Meta-analysis of Individual Participant Data. MAIN OUTCOMES AND MEASURES The primary outcome was target vessel failure (TVF) at 2 years, a composite of cardiac death, target vessel myocardial infarction (TVMI), and target vessel revascularization (TVR). The secondary outcome was a composite of cardiac death or TVMI at 2 years. RESULTS Of 2268 articles identified, 29 studies met selection criteria. Of these, 28 articles from 17 cohorts provided data, including a total of 5277 patients with 5869 vessels who underwent FFR measurement after DES implantation. Mean (SD) age was 64.4 (10.1) years and 4141 patients (78.5%) were men. Median (IQR) post-PCI FFR was 0.89 (0.84-0.94) and 690 vessels (11.8%) had a post-PCI FFR of 0.80 or below. The cumulative incidence of TVF was 340 patients (7.2%), with cardiac death or TVMI occurring in 111 patients (2.4%) at 2 years. Lower post-PCI FFR significantly increased the risk of TVF (adjusted hazard ratio [HR] per 0.01 FFR decrease, 1.04; 95% CI, 1.02-1.05; P < .001). The risk of cardiac death or MI also increased inversely with post-PCI FFR (adjusted HR, 1.03; 95% CI, 1.00-1.07, P = .049). These associations were consistent regardless of age, sex, the presence of hypertension or diabetes, and clinical diagnosis. CONCLUSIONS AND RELEVANCE Reduced FFR after DES implantation was common and associated with the risks of TVF and of cardiac death or TVMI. These results indicate the prognostic value of post-PCI physiologic assessment after DES implantation.
Collapse
Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiesuck Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Minsang Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jun Pil Yun
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Hospital, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Gabor G. Toth
- University Heart Centre Graz, Medical University Graz, Austria
| | - Zsolt Piroth
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - Nils P. Johnson
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston
| | - Nico H. J. Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Abdul Hakeem
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Barry F. Uretsky
- Central Arkansas VA Health System, Little Rock, Arkansas
- University of Arkansas for Medical Sciences, Little Rock
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akiko Matsuo
- Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | - Massoud A. Leesar
- Division of Cardiovascular Diseases, University of Alabama, Birmingham
| | - Tara Neleman
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Nicolas M. van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Damien Collison
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - Bernard De Bruyne
- Cardiovascular Center Aalst, Aalst, Belgium
- Department of Cardiology, University of Lausanne, Switzerland
| |
Collapse
|
14
|
Impact of trans-stent gradient on outcome after PCI: results from a HAWKEYE substudy. Int J Cardiovasc Imaging 2022; 38:2819-2827. [DOI: 10.1007/s10554-022-02708-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
AbstractTo test whether quantitative flow ratio (QFR)-based trans-stent gradient (TSG) is associated with adverse clinical events at follow-up. A post-hoc analysis of the multi-center HAWKEYE study was performed. Vessels post-PCI were divided into four groups (G) as follows: G1: QFR ≥ 0.90 TSG = 0 (n = 412, 54.8%); G2: QFR ≥ 0.90, TSG > 0 (n = 216, 28.7%); G3: QFR < 0.90, TSG = 0 (n = 37, 4.9%); G4: QFR < 0.90, TSG > 0 (n = 86, 11.4%). Cox proportional hazards regression model was used to analyze the effect of baseline and prognostic variables. The final reduced model was obtained by backward stepwise variable selection. Receiver operating characteristic (ROC) was plotted and area under the curve (AUC) was calculated and reported. Overall, 449 (59.8%) vessels had a TSG = 0 whereas (40.2%) had TSG > 0. Ten (2.2%) vessel-oriented composite endpoint (VOCE) occurred in vessels with TSG = 0, compared with 43 (14%) in vessels with TSG > 0 (p < 0.01). ROC analysis showed an AUC of 0.74 (95% CI: 0.67 to 0.80; p < 0.001). TSG > 0 was an independent predictor of the VOCE (HR 2.95 [95% CI 1.77–4.91]). The combination of higher TSG and lower final QFR (G4) showed the worst long-term outcome while low TSG and high QFR showed the best outcome (G1) while either high TSG or low QFR (G2, G3) showed intermediate and comparable outcomes. Higher trans-stent gradient was an independent predictor of adverse events and identified a subgroup of patients at higher risk for poor outcomes even when vessel QFR was optimal (> 0.90).
Collapse
|
15
|
Impact of post physiological assessment after treatment for de novo coronary lesions using drug-coated balloons. Int J Cardiol 2022; 363:11-19. [DOI: 10.1016/j.ijcard.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/28/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022]
|
16
|
Takahashi T, Shin D, Kuno T, Lee JM, Latib A, Fearon WF, Maehara A, Kobayashi Y. Diagnostic performance of fractional flow reserve derived from coronary angiography, intravascular ultrasound, and optical coherence tomography; a meta-analysis. J Cardiol 2022; 80:1-8. [DOI: 10.1016/j.jjcc.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/06/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
|
17
|
Patel MR, Jeremias A, Maehara A, Matsumura M, Zhang Z, Schneider J, Tang K, Talwar S, Marques K, Shammas NW, Gruberg L, Seto A, Samady H, Sharp ASP, Ali ZA, Mintz G, Davies J, Stone GW. 1-Year Outcomes of Blinded Physiological Assessment of Residual Ischemia After Successful PCI: DEFINE PCI Trial. JACC Cardiovasc Interv 2022; 15:52-61. [PMID: 34991824 DOI: 10.1016/j.jcin.2021.09.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to identify the post-percutaneous coronary intervention (PCI) target value of instantaneous wave-free ratio (iFR) that would best discriminate clinical events at 1 year in the DEFINE PCI (Physiologic Assessment of Coronary Stenosis Following PCI) study. BACKGROUND The impact of residual ischemia detected by iFR post-PCI on clinical and symptom-related outcomes is unknown. METHODS Blinded iFR pull back was performed after successful stent implantation in 500 patients. The primary endpoint was the rate of residual ischemia, defined as iFR ≤0.89, after operator-assessed angiographically successful PCI. Secondary endpoints included clinical events at 1 year and change in Seattle Angina Questionnaire angina frequency (SAQ-AF) score during follow-up. RESULTS As reported, 24.0% of patients had residual ischemia (iFR ≤0.89) after successful PCI, with 81.6% of cases attributable to angiographically inapparent focal lesions. Post-PCI iFR ≥0.95 (present in 182 cases [39%]) was associated with a significant reduction in the composite of cardiac death, spontaneous myocardial infarction, or clinically driven target vessel revascularization compared with post-PCI iFR <0.95 (1.8% vs 5.7%; P = 0.04). Baseline SAQ-AF score was 73.3 ± 22.8. For highly symptomatic patients (baseline SAQ-AF score ≤60), SAQ-AF score increased by ≥10 points more frequently in patients with versus without post-PCI iFR ≥0.95 (100.0% vs 88.5%; P = 0.01). CONCLUSIONS In DEFINE PCI, despite angiographically successful PCI, highly symptomatic patients at baseline without residual ischemia by post-PCI iFR had greater reductions in anginal symptoms at 1 year compared with patients with residual ischemia. Achieving post-PCI iFR ≥0.95 was also associated with improved 1-year event-free survival. (Physiologic Assessment of Coronary Stenosis Following PCI [DEFINE PCI]; NCT03084367).
Collapse
Affiliation(s)
- Manesh R Patel
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
| | - Allen Jeremias
- St. Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Mitsuaki Matsumura
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Zixuan Zhang
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Joel Schneider
- North Carolina Heart and Vascular, Raleigh, North Carolina, USA
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Suneel Talwar
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Koen Marques
- VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Arnold Seto
- Veterans Affairs Medical Center of Long Beach, Long Beach, California, USA
| | - Habib Samady
- Emory University Hospital, Atlanta, Georgia, USA
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, United Kingdom; University of Exeter, Exeter, United Kingdom
| | - Ziad A Ali
- St. Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Gary Mintz
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
18
|
Vallurupalli S, Salehi N, Agarwal S, Hasan R, Hassan A, Siraj A, Madmani ME, Rafeedheen R, Ayan M, Al-Hawwas M, Hakeem A, Uretsky BF. Exhaustion of coronary vasodilatory reserve in the resting state: Clinical characteristics and long-term outcomes after intervention. Catheter Cardiovasc Interv 2021; 98:1021-1026. [PMID: 34499399 DOI: 10.1002/ccd.29945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/29/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/BACKGROUND Resting coronary blood flow approximates flow with maximal vasodilation in very severe coronary stenosis. We studied the incidence of exhausted vasodilatory reserve by FFR, its clinical characteristics and long-term prognosis after FFR guided percutaneous coronary intervention (PCI). METHODS Consecutive patients undergoing FFR-guided PCI for coronary stenosis with reduced resting blood flow (baseline Pd/Pa < 0.8) were included. Basal maximal vasodilation (BMV) was defined as less than 5% difference between resting Pd/Pa and FFR, that is, FFR-baseline Pd/Pa < 0.05. RESULTS Of 658 vessels that underwent FFR-guided PCI in 602 patients, 151 vessels had resting blood flow in the ischemic range (baseline Pd/Pa ≤ 0.8) and were included in the analysis. Of these, 28 lesions in 28 patients met criteria for BMV (4.25% of the entire registry and 18.5% of those with the reduced basal coronary flow). Stenosis severity was a significant predictor of the presence of BMV. In long term follow-up (median 106 ± 3.6 months), BMV was not associated with increased target vessel revascularization (TVR) or major adverse cardiac event compared to non-BMV(OR 1.9, 95% CI 0.7-4.8, p-value 0.2 and OR 1.3, 95% CI 0.75-2.5, p = 0.3, respectively). CONCLUSION Low baseline Pd/Pa that approximates fractional flow reserve (exhausted vasodilatory reserve) defines a subgroup of patients with severe coronary artery stenosis. Prognosis, when treated with PCI along with medical therapy, appears similar to those with intact vasodilatory reserve.
Collapse
Affiliation(s)
- Srikanth Vallurupalli
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Cardiology Section, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Negar Salehi
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Shiv Agarwal
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Cardiology Section, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Rimsha Hasan
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Atif Hassan
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Aisha Siraj
- Cardiology, MetroHealth Medical Center, Cleveland, Ohio, USA
| | | | - Rahil Rafeedheen
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mohamed Ayan
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Malek Al-Hawwas
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Cardiology Section, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Abdul Hakeem
- Division of Cardiology, Rutgers University, New Brunswick, New Jersey, USA
| | - Barry F Uretsky
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Cardiology Section, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| |
Collapse
|
19
|
Zhang J, Hwang D, Yang S, Kim CH, Lee JM, Nam CW, Shin ES, Doh JH, Hoshino M, Hamaya R, Kanaji Y, Murai T, Zhang JJ, Ye F, Li X, Ge Z, Chen SL, Kakuta T, Koo BK. Differential Prognostic Implications of Pre- and Post-Stent Fractional Flow Reserve in Patients Undergoing Percutaneous Coronary Intervention. Korean Circ J 2021; 52:47-59. [PMID: 34877828 PMCID: PMC8738713 DOI: 10.4070/kcj.2021.0128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 01/10/2023] Open
Abstract
The current study showed that pre-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) was associated with target vessel failure (TVF) after PCI. When the prognostic value of post-PCI FFR was evaluated according to pre-PCI FFR value, the risk of TVF significantly decreased along with the increase of post-PCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Our study results suggest that patient prognosis can be varied according to the level of physiologic indices, both before and after PCI, and the integration of both information can provide better risk stratification after PCI. Background and Objectives The influence of pre-intervention coronary physiologic status on outcomes post percutaneous coronary intervention (PCI) is not well known. We sought to investigate the prognostic implications of pre-PCI fractional flow reserve (FFR) combined with post-PCI FFR. Methods A total of 1,479 PCI patients with pre-and post-PCI FFR data were analyzed. The patients were classified according to the median values of pre-PCI FFR (0.71) and post-PCI FFR (0.88). The primary outcome was target vessel failure (TVF) at 2 years. Results The risk of TVF was higher in the low pre-PCI FFR group than in the high pre-PCI FFR group (hazard ratio, 1.82; 95% confidence interval, 1.15–2.87; p=0.011). In 4 group comparisons, the cumulative incidences of TVF at 2 years were 3.8%, 4.1%, 4.8%, and 10.2% in the high pre-/high post-, low pre-/high post-, high pre-/low post-, and low pre-/low post-PCI FFR groups, respectively. The risk of TVF was the highest in the low pre-/low post-PCI FFR group among the groups (p values for comparisons <0.05). In addition, the high pre-/low post-PCI FFR group presented a comparable risk of TVF with the high post-PCI FFR groups (p values for comparison >0.05). When the prognostic value of the post-PCI FFR was evaluated according to the pre-PCI FFR, the risk of TVF significantly decreased with an increase in post-PCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Conclusions Pre-PCI FFR was associated with clinical outcomes after PCI, and the prognostic value of post-PCI FFR differed according to the pre-PCI FFR. Trial Registration ClinicalTrials.gov Identifier: NCT04012281
Collapse
Affiliation(s)
- Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Chee Hae Kim
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Hospital, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea.
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaobo Li
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
| |
Collapse
|
20
|
Residual Quantitative Flow Ratio to Estimate Post-Percutaneous Coronary Intervention Fractional Flow Reserve. J Interv Cardiol 2021; 2021:4339451. [PMID: 34548847 PMCID: PMC8426071 DOI: 10.1155/2021/4339451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Quantitative flow ratio (QFR) computes fractional flow reserve (FFR) based on invasive coronary angiography (ICA). Residual QFR estimates post‐percutaneous coronary intervention (PCI) FFR. This study sought to assess the relationship of residual QFR with post-PCI FFR. Methods Residual QFR analysis, using pre-PCI ICA, was attempted in 159 vessels with post-PCI FFR. QFR lesion location was matched with the PCI location to simulate the performed intervention and allow computation of residual QFR. A post-PCI FFR < 0.90 was used to define a suboptimal PCI result. Results Residual QFR computation was successful in 128 (81%) vessels. Median residual QFR was higher than post-PCI FFR (0.96 Q1–Q3: 0.91–0.99 vs. 0.91 Q1–Q3: 0.86–0.96, p < 0.001). A significant correlation and agreement were observed between residual QFR and post-PCI FFR (R = 0.56 and intraclass correlation coefficient = 0.47, p < 0.001 for both). Following PCI, an FFR < 0.90 was observed in 54 (42%) vessels. Specificity, positive predictive value, sensitivity, and negative predictive value of residual QFR for assessment of the PCI result were 96% (95% confidence interval (CI): 87–99%), 89% (95% CI: 72–96%), 44% (95% CI: 31–59%), and 70% (95% CI: 65–75%), respectively. Residual QFR had an accuracy of 74% (95% CI: 66–82%) and an area under the receiver operating characteristic curve of 0.79 (95% CI: 0.71–0.86). Conclusions A significant correlation and agreement between residual QFR and post-PCI FFR were observed. Residual QFR ≥ 0.90 did not necessarily commensurate with a satisfactory PCI (post-PCI FFR ≥ 0.90). In contrast, residual QFR exhibited a high specificity for prediction of a suboptimal PCI result.
Collapse
|
21
|
Zimbardo G, Cialdella P, DI Giusto F, Migliaro S, Anastasia G, Petrolati E, Galante D, D'Amario D, Leone AM. Physiological assessment after percutaneous coronary intervention: the hard truth. Panminerva Med 2021; 63:519-528. [PMID: 34486363 DOI: 10.23736/s0031-0808.21.04363-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Physiologically guided revascularization, using Fractional Flow Reserve (FFR) or instantaneous wave free ratio (iFR) has been demonstrated to be associated with better long-term outcomes compared to an angiographically-guided strategy, mainly avoiding inappropriate coronary stenting and its associated adverse events. On the contrary, the role of invasive physiological assessment after percutaneous coronary intervention (PCI) is much less well established. However, a large body of evidence suggests that a relevant proportion of patients undergoing PCI with a satisfying angiographic result show instead a suboptimal functional product with a potentially negative prognostic impact. For this reason, many efforts have been focused to identify interventional strategies to physiologically optimize PCI. Measuring the functional result after as PCI, especially when performed after a physiological assessment, implies that the operator is ready to accept the hard truth of an unsatisfactory physiological result despite angiographically optimal and, consequently, to optimize the product with some additional effort. The aim of this review is to bridge this gap in knowledge by better defining the paradigm shift of invasive physiological assessment from a simple tool for deciding whether an epicardial stenosis has to be treated to a thoroughly physiological approach to PCI with the suggestion of a practical flow chart.
Collapse
Affiliation(s)
| | | | - Federico DI Giusto
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Migliaro
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianluca Anastasia
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edoardo Petrolati
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico Galante
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio M Leone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy -
| |
Collapse
|
22
|
Agarwal SK, Hakeem A, Hasan R, Ayan M, Siraj A, Madmani ME, Rafeedheen R, Salehi N, Kasula S, Hacioglu Y, Miller K, Vallurupalli S, Al-Hawwas M, Uretsky BF. Fractional Flow Reserve After Functionally Optimized Coronary Intervention Predicts Very Long-Term Outcomes. JACC Cardiovasc Interv 2021; 14:355-356. [PMID: 33541550 DOI: 10.1016/j.jcin.2020.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022]
|
23
|
Invasive Coronary Physiology After Stent Implantation: Another Step Toward Precision Medicine. JACC Cardiovasc Interv 2021; 14:237-246. [PMID: 33541534 DOI: 10.1016/j.jcin.2020.10.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 01/10/2023]
Abstract
Intracoronary physiology is routinely used in setting the indication for percutaneous coronary intervention (PCI) but seldom in assessing procedural results. This attitude is increasingly challenged by accumulated evidence demonstrating the value of post-PCI functional assessment in predicting long-term patient outcomes. Besides fractional flow reserve, a number of new indexes recently incorporated to clinical practice, including nonhyperemic pressure and functional angiographic indexes, provide new opportunities for the physiological assessment of PCI results. Largely, the benefit of these tools is derived from longitudinal analysis of the treated vessel, which allows precise identification of the vessel segment accounting for a suboptimal functional result and enabling operators to perform accurate PCI optimization. In this document the authors review available evidence supporting why physiological assessment should be extended to immediate post-PCI with the aim of improving patient outcomes. A step-by-step guide on how available physiological tools can be used for such purpose is provided.
Collapse
|
24
|
Belguidoum S, Meneveau N, Motreff P, Ohlman P, Boussaada M, Silvain J, Guillon B, Descotes-Genon V, Lefrançois Y, Morel O, Amabile N. Relationship between stent expansion and fractional flow reserve after percutaneous coronary intervention: a post hoc analysis of the DOCTORS trial. EUROINTERVENTION 2021; 17:e132-e139. [PMID: 32392171 PMCID: PMC9724874 DOI: 10.4244/eij-d-19-01103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The best criteria for adequate stent expansion assessment by intracoronary imaging remain debated and their correlation with post-PCI FFR values is unknown. AIMS This study aimed to analyse the relationship between stent expansion criteria using optical coherence tomography (OCT) analysis and the final PCI functional result. METHODS This post hoc analysis of the DOCTORS study included non-ST-elevation segment ACS patients undergoing OCT-guided PCI. The procedure functional result was assessed by the measurement of fractional flow reserve (FFR). Stent expansion was assessed on OCT runs according to the DOCTORS criteria and ILUMIEN III criteria. RESULTS The study included N=116 patients (age: 60.8±11.5 years; male gender: 71%). The final expansion was considered optimal in 10%, acceptable in 9% and unacceptable in 81% of the stents according to ILUMIEN III criteria, although being successful in 70% of the patients according to the DOCTORS criteria. Hypertension and larger proximal reference segment dimension were independent predictors of inadequate device ILUMIEN III expansion. FFR values were, respectively, 0.93 (0.91-0.95) versus 0.95 (0.92-0.97) in patients with optimal+acceptable versus unacceptable ILUMIEN III expansion (p=0.22), 0.94 (0.91-0.97) versus 0.95 (0.93-0.97) in patients with optimal versus non-optimal DOCTORS expansion (p=0.23), and 0.95 (0.92-0.97) versus 0.92 (0.90-0.95) in patients with minimal stent area ≥4.5 mm2 versus <4.5 mm2 (p=0.03). CONCLUSIONS In this selected population, no relationship was observed between optimal stent expansion according to ILUMIEN III or DOCTORS OCT criteria and final post-PCI FFR values.
Collapse
Affiliation(s)
- Salim Belguidoum
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | - Pascal Motreff
- Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
| | - Patrick Ohlman
- Department of Cardiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Mohamed Boussaada
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | | | | | - Olivier Morel
- Department of Cardiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France
| |
Collapse
|
25
|
Hakeem A, Hou L, Shah K, Agarwal SK, Almomani A, Edupuganti M, Kasula S, Pothineni NV, Al-Hawwas M, Miller K, Zakir R, Ghosh B, Uretsky BF. Derivation and validation of Pd/Pa in the assessment of residual ischemia post-intervention: A prospective all-comer registry. Catheter Cardiovasc Interv 2021; 99:714-722. [PMID: 34101336 DOI: 10.1002/ccd.29790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/27/2021] [Accepted: 05/13/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Measurement of post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) demonstrates residual ischemia in a large percentage of cases deemed angiographically successful which, in turn, has been associated with worse long-term outcomes. It has recently been shown that a resting pressure index, Pd/Pa, has prognostic value post stenting, however, its diagnostic value relative to FFR post-PCI has not been evaluated. METHODS The diagnostic accuracy of Pd/Pa in identifying ischemia (FFR≤0.80) pre- and post-PCI was evaluated. Three patient subsets were analyzed. A reference pre-PCI cohort of 1,255 patients (1,560 vessels) was used to measure the accuracy of pre-PCI Pd/Pa vs. FFR. A derivation post-PCI group of 574 patient (664 vessels) was then used to calculate the diagnostic accuracy of post-PCI Pd/Pa vs. FFR. A final prospective validation cohort of 230 patients (255 vessels) was used to test and validate the diagnostic performance of post-PCI Pd/Pa. RESULTS Median Pd/Pa and FFR were 0.90 (IQR 0.90-0.98) and 0.80 (IQR 0.71-0.88) in the reference pre-PCI model, 0.96 (IQR 0.93-1.00) and 0.87 (IQR 0.77-0.90) in the post-PCI derivation model, and 0.94 (IQR 0.89-0.97) and 0.84 (IQR 0.77-0.90) in the post-PCI validation model respectively. There was a strong linear correlation between Pd/Pa and FFR in all three models (p < 0.0001). Using ROC analysis, the optimal Pd/Pa cutoff value to predict a FFR ≤ 0.80 was ≤0.92 (AUC 0.87) in the pre-PCI model, ≤0.93 (AUC 0.85) in the post-PCI derivation model, and ≤ 0.90 (AUC 0.91) in the post-PCI validation model. Using a hybrid strategy of post-PCI Pd/Pa and post-PCI FFR when necessary (25% patients), overall diagnostic accuracy was improved to 95%. CONCLUSIONS Pd/Pa has excellent diagnostic accuracy for identifying ischemia post-intervention. Using a hybrid strategy of post-PCI Pd/Pa first, and FFR afterwards, if required, adenosine administration can be avoided in over 75% of physiologic assessments post intervention.
Collapse
Affiliation(s)
- Abdul Hakeem
- Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Linle Hou
- Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kulin Shah
- Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Shiv K Agarwal
- John L McClellan Memorial Veterans Hospital, Central Arkansas VA Healthy System, Little Rock, Arkansas, USA
| | - Ahmed Almomani
- John L McClellan Memorial Veterans Hospital, Central Arkansas VA Healthy System, Little Rock, Arkansas, USA
| | - Mallik Edupuganti
- John L McClellan Memorial Veterans Hospital, Central Arkansas VA Healthy System, Little Rock, Arkansas, USA
| | - Sirkanth Kasula
- John L McClellan Memorial Veterans Hospital, Central Arkansas VA Healthy System, Little Rock, Arkansas, USA
| | - Naga V Pothineni
- John L McClellan Memorial Veterans Hospital, Central Arkansas VA Healthy System, Little Rock, Arkansas, USA
| | - Malek Al-Hawwas
- John L McClellan Memorial Veterans Hospital, Central Arkansas VA Healthy System, Little Rock, Arkansas, USA
| | - Kristin Miller
- John L McClellan Memorial Veterans Hospital, Central Arkansas VA Healthy System, Little Rock, Arkansas, USA
| | - Ramzan Zakir
- Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Bobby Ghosh
- Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Barry F Uretsky
- John L McClellan Memorial Veterans Hospital, Central Arkansas VA Healthy System, Little Rock, Arkansas, USA
| |
Collapse
|
26
|
Takahashi K, Serruys PW, Gao C, Ono M, Wang R, Thuijs DJFM, Mack MJ, Curzen N, Mohr FW, Davierwala P, Milojevic M, Wykrzykowska JJ, de Winter RJ, Sharif F, Onuma Y, Head SJ, Kappetein AP, Morice MC, Holmes DR. Ten-Year All-Cause Death According to Completeness of Revascularization in Patients With Three-Vessel Disease or Left Main Coronary Artery Disease: Insights From the SYNTAX Extended Survival Study. Circulation 2021; 144:96-109. [PMID: 34011163 DOI: 10.1161/circulationaha.120.046289] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ten-year all-cause death according to incomplete (IR) versus complete revascularization (CR) has not been fully investigated in patients with 3-vessel disease and left main coronary artery disease undergoing percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). METHODS The SYNTAX Extended Survival study (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]) evaluated vital status up to 10 years in patients who were originally enrolled in the SYNTAX trial. In the present substudy, outcomes of the CABG CR group were compared with the CABG IR, PCI CR, and PCI IR groups. In addition, in the PCI cohort, the residual SYNTAX score (rSS) was used to quantify the extent of IR and to assess its association with fatal late outcome. The rSS of 0 suggests CR, whereas a rSS>0 identifies the degree of IR. RESULTS IR was more frequently observed in patients with PCI versus CABG (56.6% versus 36.8%) and more common in those with 3-vessel disease than left main coronary artery disease in both the PCI arm (58.5% versus 53.8%) and the CABG arm (42.8% versus 27.5%). Patients undergoing PCI with CR had no significant difference in 10-year all-cause death compared with those undergoing CABG (22.2% for PCI with CR versus 24.3% for CABG with IR versus 23.8% for CABG with CR). In contrast, those with PCI and IR had a significantly higher risk of all-cause death at 10 years compared with CABG and CR (33.5% versus 23.7%; adjusted hazard ratio, 1.48 [95% CI, 1.15-1.91]). When patients with PCI were stratified according to the rSS, those with a rSS≤8 had no significant difference in all-cause death at 10 years as the other terciles (22.2% for rSS=0 versus 23.9% for rSS>0-4 versus 28.9% for rSS>4-8), whereas a rSS>8 had a significantly higher risk of 10-year all-cause death than those undergoing PCI with CR (50.1% versus 22.2%; adjusted hazard ratio, 3.40 [95% CI, 2.13-5.43]). CONCLUSIONS IR is common after PCI, and the degree of incompleteness was associated with 10-year mortality. If it is unlikely that complete (or nearly complete; rSS<8) revascularization can be achieved with PCI in patients with 3-vessel disease, CABG should be considered. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00114972. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03417050.
Collapse
Affiliation(s)
- Kuniaki Takahashi
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, The Netherlands (K.T., M.O., J.J.W., R.J.d.W.)
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (P.W.S., Y.O.)
| | - Chao Gao
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands (C.G., R.W.)
| | - Masafumi Ono
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, The Netherlands (K.T., M.O., J.J.W., R.J.d.W.)
| | - Rutao Wang
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands (C.G., R.W.)
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (D.J.F.M.T., M.M., S.J.H., A.P.K.)
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor Scott & White Health, Dallas, TX (M.J.M.)
| | - Nick Curzen
- Department of Cardiology, University Hospital Southampton NHS FT, UK (N.C.)
| | | | - Piroze Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Germany (F.-W.M., P.D.).,Now with Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Ontario, Canada (P.D.)
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (D.J.F.M.T., M.M., S.J.H., A.P.K.).,Department of Cardiothoracic Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia (M.M.)
| | - Joanna J Wykrzykowska
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, The Netherlands (K.T., M.O., J.J.W., R.J.d.W.).,Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands (J.J.W.)
| | - Robbert J de Winter
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, The Netherlands (K.T., M.O., J.J.W., R.J.d.W.)
| | - Faisal Sharif
- CURAM, Cardiovascular Research and Innovation Centre (CVRI), BioInnovate Ireland, Department of Cardiology, Galway University Hospital and National University of Ireland, Ireland (F.S.)
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (P.W.S., Y.O.)
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (D.J.F.M.T., M.M., S.J.H., A.P.K.)
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (D.J.F.M.T., M.M., S.J.H., A.P.K.)
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, France (M.-C.M.)
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (D.R.H.)
| | | |
Collapse
|
27
|
Ai H, Zheng N, Li L, Yang G, Li H, Tang G, Zhou Q, Zhang H, Yu X, Xu F, Zhao Y, Sun F. Agreement of Angiography-Derived and Wire-Based Fractional Flow Reserves in Percutaneous Coronary Intervention. Front Cardiovasc Med 2021; 8:654392. [PMID: 33969017 PMCID: PMC8102686 DOI: 10.3389/fcvm.2021.654392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Coronary angiography-derived fractional flow reserve (caFFR) measurements have shown good correlations and agreement with invasive wire-based fractional flow reserve (FFR) measurements. However, few studies have examined the diagnostic performance of caFFR measurements before and after percutaneous coronary intervention (PCI). This study sought to compare the diagnostic performance of caFFR measurements against wire-based FFR measurements in patients before and after PCI. Methods: Patients who underwent FFR-guided PCI were eligible for the acquisition of caFFR measurements. Offline caFFR measurements were performed by blinded hospital operators in a core laboratory. The primary endpoint was the vessel-oriented composite endpoint (VOCE), defined as a composite of vessel-related cardiovascular death, vessel-related myocardial infarction, and target vessel revascularization. Results: A total of 105 pre-PCI caFFR measurements and 65 post-PCI caFFR measurements were compared against available wire-based FFR measurements. A strong linear correlation was found between wire-based FFR and caFFR measurements (r = 0.77; p < 0.001) before PCI, and caFFR measurements also showed a high correlation (r = 0.82; p < 0.001) with wire-based FFR measurements after PCI. A total of 6 VOCEs were observed in 61 patients during follow-up. Post-PCI FFR values (≤0.82) in the target vessel was the strongest predictor of VOCE [hazard ratio (HR): 5.59; 95% confidence interval (CI): 1.12–27.96; p = 0.036). Similarly, patients with low post-PCI caFFR values (≤0.83) showed an 8-fold higher risk of VOCE than those with high post-PCI caFFR values (>0.83; HR: 8.83; 95% CI: 1.46–53.44; p = 0.017). Conclusion: The study showed that the caFFR measurements were well-correlated and in agreement with invasive wire-based FFR measurements before and after PCI. Similar to wire-based FFR measurements, post-PCI caFFR measurements can be used to identify patients with a higher risk for adverse events associated with PCI.
Collapse
Affiliation(s)
- Hu Ai
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Naixin Zheng
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Le Li
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Guojian Yang
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Li
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Guodong Tang
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Zhou
- The MOH Key Laboratory of Geriatrics, National Center of Gerontology, Beijing Hospital, Beijing, China
| | - Huiping Zhang
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xue Yu
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Xu
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Zhao
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Fucheng Sun
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
28
|
Ono M, Onuma Y, Serruys PW. The era of single angiographic view for physiological assessment has come. Is simplification the ultimate sophistication? Catheter Cardiovasc Interv 2021; 97 Suppl 2:964-965. [DOI: 10.1002/ccd.29662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Masafumi Ono
- Department of Cardiology, Academic Medical Center University of Amsterdam Amsterdam The Netherlands
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Yoshinobu Onuma
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
| | - Patrick W. Serruys
- Department of Cardiology National University of Ireland, Galway (NUIG) Galway Ireland
- NHLI Imperial College London London UK
| |
Collapse
|
29
|
Argacha JF, Decamp J, Vandeloo B, Babin D, Lochy S, Van den Bussche K, de Hemptinne Q, Xaplanteris P, Magne J, Segers P, Cosyns B. Guiding Myocardial Revascularization by Algorithmic Interpretation of FFR Pullback Curves: A Proof of Concept Study. Front Cardiovasc Med 2021; 8:623841. [PMID: 33778020 PMCID: PMC7990785 DOI: 10.3389/fcvm.2021.623841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/19/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Coronary artery disease distribution along the vessel is a main determinant of FFR improvement after PCI. Identifying focal from diffuse disease from visual inspections of coronary angiogram (CA) and FFR pullback (FFR-PB) are operator-dependent. Computer science may standardize interpretations of such curves. Methods: A virtual stenting algorithm (VSA) was developed to perform an automated FFR-PB curve analysis. A survey analysis of the evaluations of 39 vessels with intermediate disease on CA and a distal FFR <0.8, rated by 5 interventional cardiologists, was performed. Vessel disease distribution and PCI strategy were successively rated based on CA and distal FFR (CA); CA and FFR-PB curve (CA/FFR-PB); and CA and VSA (CA/VSA). Inter-rater reliability was assessed using Fleiss kappa and an agreement analysis of CA/VSA rating with both algorithmic and human evaluation (operator) was performed. We hypothesize that VSA would increase rater agreement in interpretation of epicardial disease distribution and subsequent evaluation of PCI eligibility. Results: Inter-rater reliability in vessel disease assessment by CA, CA/FFR-PB, and CA/VSA were respectively, 0.32 (95% CI: 0.17-0.47), 0.38 (95% CI: 0.23-0.53), and 0.4 (95% CI: 0.25-0.55). The raters' overall agreement in vessel disease distribution and PCI eligibility was higher with the VSA than with the operator (respectively, 67 vs. 42%, and 80 vs. 70%, both p < 0.05). Compared to CA/FFR-PB, CA/VSA induced more reclassification toward a focal disease (92 vs. 56.2%, p < 0.01) with a trend toward more reclassification as eligible for PCI (70.6 vs. 33%, p = 0.06). Change in PCI strategy did not differ between CA/FFR-PB and CA/VSA (23.6 vs. 28.5%, p = 0.38). Conclusions: VSA is a new program to facilitate and standardize the FFR pullback curves analysis. When expert reviewers integrate VSA data, their assessments are less variable which might help to standardize PCI eligibility and strategy evaluations. Clinical Trial Registration: https://www.clinicaltrials.gov/ct2/show/NCT03824600.
Collapse
Affiliation(s)
- Jean-François Argacha
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jean Decamp
- Centre for Quantum Technologies, National University of Singapore, Singapore, Singapore
| | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Danilo Babin
- imec-TELIN-IPI, Ghent University, Ghent, Belgium
| | - Stijn Lochy
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Karen Van den Bussche
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Quentin de Hemptinne
- Department of Cardiology, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Panagiotis Xaplanteris
- Department of Cardiology, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Julien Magne
- Department of Cardiology, Dupuytren University Hospital 2, Limoges, France.,INSERM U1094 and IRD, Limoges University, Limoges, France
| | - Patrick Segers
- Department of Electronics and Information Systems, IBiTech-bioMMeda, Ghent University, Ghent, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
30
|
Diletti R, Masdjedi K, Daemen J, van Zandvoort LJ, Neleman T, Wilschut J, Den Dekker WK, van Bommel RJ, Lemmert M, Kardys I, Cummins P, de Jaegere P, Zijlstra F, Van Mieghem NM. Impact of Poststenting Fractional Flow Reserve on Long-Term Clinical Outcomes: The FFR-SEARCH Study. Circ Cardiovasc Interv 2021; 14:e009681. [PMID: 33685214 PMCID: PMC7982137 DOI: 10.1161/circinterventions.120.009681] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Kaneshka Masdjedi
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Laurens J.C. van Zandvoort
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Tara Neleman
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Wijnand K. Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | | | - Miguel Lemmert
- Department of Cardiology, Isala Hospital, Zwolle, the Netherlands (M.L.)
| | - Isabella Kardys
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Paul Cummins
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Peter de Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Nicolas M. Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| |
Collapse
|
31
|
Hwang D, Lee JM, Yang S, Chang M, Zhang J, Choi KH, Kim CH, Nam CW, Shin ES, Kwak JJ, Doh JH, Hoshino M, Hamaya R, Kanaji Y, Murai T, Zhang JJ, Ye F, Li X, Ge Z, Chen SL, Kakuta T, Koo BK. Role of Post-Stent Physiological Assessment in a Risk Prediction Model After Coronary Stent Implantation. JACC Cardiovasc Interv 2021; 13:1639-1650. [PMID: 32703590 DOI: 10.1016/j.jcin.2020.04.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to develop a risk model incorporating clinical, angiographic, and physiological parameters to predict future clinical events after drug-eluting stent implantation. BACKGROUND Prognostic factors after coronary stenting have not been comprehensively investigated. METHODS A risk model to predict target vessel failure (TVF) at 2 years was developed from 2,200 patients who underwent second-generation drug-eluting stent implantation and post-stent fractional flow reserve (FFR) measurement. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization. A random survival forest model with automatic feature selection by minimal depth analysis was used for risk model development. RESULTS During 2 years of follow-up, the cumulative incidence of TVF was 5.9%. From clinical, angiographic, and physiological parameters, 6 variables were selected for the risk model in order of importance within the model as follows: total stent length, post-stent FFR, age, post-stent percentage diameter stenosis, reference vessel diameter, and diabetes mellitus. Harrell's C index of the random survival forest model was 0.72 (95% confidence interval [CI]: 0.62 to 0.82). This risk model showed better prediction ability than models with clinical risk factors alone (Harrell's C index = 0.55; 95% CI: 0.41 to 0.59; p for comparison = 0.005) and with clinical risk factors and angiographic parameters (Harrell's C index = 0.65; 95% CI: 0.52 to 0.77; p for comparison = 0.045). When the patients were divided into 2 groups according to the median of total stent length (30 mm), post-stent FFR and total stent length showed the highest variable importance in the short- and long-stent groups, respectively. CONCLUSIONS A risk model incorporating clinical, angiographic, and physiological predictors can help predict the risk for TVF at 2 years after coronary stenting. Total stent length and post-stent FFR were the most important predictors. (International Post PCI FFR Registry; NCT04012281).
Collapse
Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Mineok Chang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jinlong Zhang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chee Hae Kim
- Division of Cardiology, Department of Internal Medicine, VHS Medical Center, Seoul, Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Hospital, Ulsan, Korea
| | - Jae-Jin Kwak
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaobo Li
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
| |
Collapse
|
32
|
Jeremias A, Stone GW. Assessing Post-Percutaneous Coronary Intervention Physiology: Is Hyperemia Necessary? JACC Cardiovasc Interv 2020; 13:1934-1936. [PMID: 32819482 DOI: 10.1016/j.jcin.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Allen Jeremias
- Department of Cardiology, St. Francis Hospital, the Heart Center, Roslyn, New York; Cardiovascular Research Foundation, New York, New York.
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
33
|
Ono M, Kawashima H, Hara H, Gao C, Wang R, Kogame N, Takahashi K, Chichareon P, Modolo R, Tomaniak M, Wykrzykowska JJ, Piek JJ, Mori I, Courtney BK, Wijns W, Sharif F, Bourantas C, Onuma Y, Serruys PW. Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging. Front Cardiovasc Med 2020; 7:119. [PMID: 32850981 PMCID: PMC7411139 DOI: 10.3389/fcvm.2020.00119] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022] Open
Abstract
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been developed and improved as both diagnostic and guidance tools for interventional procedures over the past three decades. IVUS has a resolution of 100 μm with a high tissue penetration and capability of assessing the entire structure of a coronary artery including the external elastic membrane, whereas OCT has a higher resolution of 10–20 μm to assess endoluminal structures with a limited tissue penetration compared to IVUS. Recently, two companies, CONAVI and TERUMO, integrated IVUS and OCT into a single catheter system. With their inherent strength and limitations, the combined IVUS and OCT probes are complementary and work synergistically to enable a comprehensive depiction of coronary artery. In this review, we summarize the performance of the two intracoronary imaging modalities—IVUS and OCT—and discuss the expected potential of the novel hybrid IVUS–OCT catheter system in the clinical field.
Collapse
Affiliation(s)
- Masafumi Ono
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hideyuki Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hironori Hara
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, Netherlands.,Depatrment of Cardiology, Xijing hospital, Xi'an, China
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, Netherlands.,Depatrment of Cardiology, Xijing hospital, Xi'an, China
| | - Norihiro Kogame
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kuniaki Takahashi
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ply Chichareon
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rodrigo Modolo
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mariusz Tomaniak
- Thoraxcentre, Erasmus Medical Centre, Rotterdam, Netherlands.,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Brian K Courtney
- Schulich Heart Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Conavi Medical, North York, ON, Canada
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| |
Collapse
|
34
|
Nazir MS, Mittal TK, Weir-McCall J, Nieman K, Channon K, Nicol ED. Opportunities and challenges of implementing computed tomography fractional flow reserve into clinical practice. Heart 2020; 106:1387-1393. [PMID: 32561589 DOI: 10.1136/heartjnl-2019-315607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
CT-derived fractional flow reserve (CT-FFR) uses computational fluid dynamics to derive non-invasive FFR to determine the haemodynamic significance of coronary artery lesions. Studies have demonstrated good diagnostic accuracy of CT-FFR and reassuring short-term clinical outcome data.As a prerequisite, high-quality CT coronary angiography (CTCA) images are required with good heart rate control and pre-treatment with glyceryl trinitrate, which would otherwise render CTCA as unsuitable for CT-FFR. CT-FFR can determine the functional significance of CAD lesions, and there are supportive data for its use in clinical decision-making. However, the downstream impact on myocardial ischaemic burden or viability cannot be obtained.Several challenges remain with implementation of CT-FFR, including interpretation, training, availability, resource utilisation and funding. Further research is required to determine which cases should be considered for clinical CT-FFR analysis, with additional practical guidance on how to implement this emerging technique in clinical practice. Furthermore, long-term prognostic data are required before widespread clinical implementation of CT-FFR can be recommended.While there are several potential opportunities for CT-FFR, at present there remain important systemic and technical limitations and challenges that need to be overcome prior to routine integration of CT-FFR into clinical practice.
Collapse
Affiliation(s)
| | | | - Jonathan Weir-McCall
- University of Cambridge School of Clinical Medicine, Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom, Cambridge, UK
| | - Koen Nieman
- Stanford University School of Medicine and Cardiovascular Institute, Stanford, California, USA
| | - Keith Channon
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Edward D Nicol
- Departments of Cardiology and Radiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
| |
Collapse
|
35
|
Kayaert P, Coeman M, Drieghe B, Bennett J, McCutcheon K, Dens J, Ungureanu C, Zivelonghi C, Agostoni P, Bataille Y, de Hemptinne Q, Gevaert S, De Pauw M, Haine S. iFR uncovers profound but mostly reversible ischemia in CTOs and helps to optimize PCI results. Catheter Cardiovasc Interv 2020; 97:646-655. [PMID: 32548976 DOI: 10.1002/ccd.29072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The study aimed to demonstrate through instant wave-free ratio (iFR) measurements that myocardium distal to a chronic total occlusion (CTO) is ischemic, that ischemia is reversible by PCI, and that iFR assessment after PCI can be used to optimize PCI results. BACKGROUND The greatest benefit of revascularization is found in patients with low fractional flow reserve. In patients with CTOs, iFR measurement may be more appropriate to evaluate ischemia as it does not require maximal microvascular vasodilation, which may be hampered by microvascular dysfunction. METHODS The iFR was measured in 81 CTO patients, both pre- and post-PCI in 63 patients, and only post-PCI in the following 18 patients. A pressure wire pullback was performed post-PCI if iFR ≤0.89. RESULTS The first 63 patients all had significant ischemia distal to the CTO with a median iFR of 0.33 [0.22; 0.44], improving significantly post-PCI to a median iFR of 0.93 [0.89;0.96] (p < .001). In the complete cohort, the median iFR post-PCI was 0.93 [0.86;0.96] but still ≤0.89 in 23 patients (30%). 12 of these patients had further PCI optimization because of a residual focal pressure gradient on pullback, after which only two had a final iFR ≤0.89. CONCLUSIONS In CTO patients with an indication for PCI, iFR consistently demonstrated profound myocardial ischemia. Successful PCI immediately relieved ischemia in 70% of patients. In the remaining 30% of cases, a manual iFR pullback proved helpful in guiding further optimization of the PCI result.
Collapse
Affiliation(s)
- Peter Kayaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Mathieu Coeman
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Benny Drieghe
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium
| | - Keir McCutcheon
- Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium
| | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Carlo Zivelonghi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | | | - Yoann Bataille
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | | | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Steven Haine
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.,Department of Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
36
|
Anderson HV“S. Acute Coronary Physiology. JACC Cardiovasc Interv 2020; 13:1168-1170. [DOI: 10.1016/j.jcin.2020.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 11/15/2022]
|
37
|
Mangiacapra F, Del Buono MG, Abbate A, Gori T, Barbato E, Montone RA, Crea F, Niccoli G. Role of endothelial dysfunction in determining angina after percutaneous coronary intervention: Learning from pathophysiology to optimize treatment. Prog Cardiovasc Dis 2020; 63:233-242. [PMID: 32061633 DOI: 10.1016/j.pcad.2020.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 02/01/2023]
Abstract
Endothelial dysfunction (EnD) is a hallmark feature of coronary artery disease (CAD), representing the key early step of atherosclerotic plaque development and progression. Percutaneous coronary intervention (PCI) is performed daily worldwide to treat symptomatic CAD, however a consistent proportion of patients remain symptomatic for angina despite otherwise successful revascularization. EnD plays a central role in the mechanisms of post-PCI angina, as it is strictly associated with both structural and functional abnormalities in the coronary arteries that may persist, or even accentuate, following PCI. The assessment of endothelial function in patients undergoing PCI might help to identify those patients at higher risk of future cardiovascular events and recurrent/persistent angina who might therefore benefit more from an intensive treatment. In this review, we address the role of EnD in determining angina after PCI, discussing its pathophysiological mechanisms, diagnostic approaches and therapeutic perspectives.
Collapse
Affiliation(s)
- Fabio Mangiacapra
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy.
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Tommaso Gori
- Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz and DZHK Standort Rhein-Main, Mainz, Germany
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
38
|
Uretsky BF, Agarwal SK, Vallurupalli S, Al-Hawwas M, Hasan R, Miller K, Hakeem A. Prospective Evaluation of the Strategy of Functionally Optimized Coronary Intervention. J Am Heart Assoc 2020; 9:e015073. [PMID: 32013707 PMCID: PMC7033880 DOI: 10.1161/jaha.119.015073] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Long‐term outcomes after percutaneous coronary intervention (PCI) relate in part to residual ischemia in the treated vessel, as reflected by post‐PCI fractional flow reserve (FFR). The strategy of FFR after PCI and treatment of residual ischemia—known as functionally optimized coronary intervention (FCI)—may be feasible and capable of improving outcomes. Methods and Results Feasibility and results of FCI using an optical‐sensor pressure wire were prospectively evaluated in an all‐comer population with 50% to 99% lesions and ischemic FFR (≤0.80; ClinicalTrials.gov identifier NCT03227588). FCI was attempted in 250 vessels in 226 consecutive patients. The PCI success rate was 99.6% (249/250 vessels). FCI technical success—that is, FFR before and after PCI and PCI itself using the FFR wire—was 92% (230/250 vessels). Incidence of residual ischemia in the treated vessel was 36.5%. Approximately a third of these vessels (34.5%, n=29) were considered appropriate for further intervention, with FFR increasing from 0.71±0.07 to 0.81±0.06 (P<0.001). Pressure wire pullback showed FFR ≤0.8 at distal stent edge was 7.9% and 0.7% proximal to the stent. FFR increase across the stent was larger in the ischemic than in the nonischemic group (0.06 [interquartile range: 0.04–0.08] versus 0.03 [interquartile range: 0.01–0.05]; P<0.0001) compatible with stent underexpansion as a contributor to residual ischemia. Conclusions FCI is a feasible and safe clinical strategy that identifies residual ischemia in a large proportion of patients undergoing angiographically successful PCI. Further intervention can improve ischemia. The impact of this strategy on long‐term outcomes needs further study.
Collapse
Affiliation(s)
- Barry F Uretsky
- Central Arkansas Veterans Health System Little Rock AR.,University of Arkansas for Medical Sciences Little Rock AR
| | - Shiv K Agarwal
- Central Arkansas Veterans Health System Little Rock AR.,University of Arkansas for Medical Sciences Little Rock AR
| | - Srikanth Vallurupalli
- Central Arkansas Veterans Health System Little Rock AR.,University of Arkansas for Medical Sciences Little Rock AR
| | - Malek Al-Hawwas
- Central Arkansas Veterans Health System Little Rock AR.,University of Arkansas for Medical Sciences Little Rock AR
| | - Rimsha Hasan
- University of Arkansas for Medical Sciences Little Rock AR
| | | | - Abdul Hakeem
- Robert Wood Johnson University Hospital Rutgers University New Brunswick NJ
| |
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW Our review discusses the management of post percutaneous coronary intervention angina (PPCIA) which negatively impacts 20-40% of patients and imposes a high burden on the healthcare system. RECENT FINDINGS Mechanisms of PPCIA include microvascular dysfunction, distal coronary vasospasm or disease, microembolization, myocardial bridge, coronary artery disease (CAD) progression, and rarely stent thrombosis or in-stent restenosis. Nitrates, beta blockers (BB), calcium channel blockers, and ranolazine are the common medical management options. Only BB showed 1-year mortality benefit following myocardial infarction. Stress echocardiography and cardiac magnetic resonance are the best to detect CAD vs. microvascular dysfunction. Invasively, vasoprovocative testing and fractional flow reserve provide useful prognostic information. If the ischemia burden is ≤10%, conservative management should be considered based upon the individual patient scenario. The optimal management of PPCIA remains unclear and further research is necessary. Multiple treatment options exist, which should be implemented in an individualized fashion.
Collapse
Affiliation(s)
- Jose B Cruz Rodriguez
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Subrata Kar
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
| |
Collapse
|
40
|
Ely Pizzato P, Samdani AJ, Vergara-Martel A, Palma Dallan LA, Tensol Rodrigues Pereira G, Zago E, Zimin V, Grando Bezerra H. Feasibility of coronary angiogram-derived vessel fractional flow reserve in the setting of standard of care percutaneous coronary intervention and its correlation with invasive FFR. Int J Cardiol 2019; 301:45-49. [PMID: 31757646 DOI: 10.1016/j.ijcard.2019.10.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Vessel Fractional Flow Reserve (vFFR), a new angiography-derived method for the functional assessment of coronaries, was recently shown to have good correlation with invasive wire-derived FFR, when vFFR-specific image acquisition requirements were followed. We sought to investigate the feasibility of vFFR analysis and its correlation with FFR in the situation where angiography is completed in routine fashion, without intention for virtual analysis. METHODS Utilizing an anonymized database maintained at our Cardiovascular Imaging Core Laboratory, we included angiographic images from patients that underwent pre- and post-PCI FFR. CAAS Workstation 8.1 software (Pie Medical Imaging) was used for vFFR evaluation. RESULTS Out of 624 angiograms (312 pre-PCI and 312 post-PCI), vFFR was successfully analyzed in 219 (35.1%) (115 pre-PCI and 104 post-PCI). Reasons for vFFR analysis failure were: <2 angiographic projections (42.5%), table movement while acquisition (25.7%) and resolution incompatibility (15%). From 115 patients with analyzable pre-PCI vFFR, 74 (64.3%) showed agreement with the respective FFR results in terms of positive (≤0.80) vs negative (>0.80) FFR. Pearson's correlation coefficient between them was 0.449 (p < 0.0001). From 104 lesions with analyzable post-PCI vFFR, 94 had availability of FFR, 74 (78.7%) of which showed agreement between the vFFR and FFR. Pearson's correlation between the values was 0.115 (p = 0.2703). CONCLUSION vFFR could be analyzed in about one-third of previously completed angiographies and a weak correlation was seen between vFFR and FFR. Our results show the importance of following the pre-specified requirements for vFFR analysis. Further studies are needed to validate the software in different settings.
Collapse
Affiliation(s)
- Patricia Ely Pizzato
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, United States of America.
| | - Abdul Jawwad Samdani
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, United States of America
| | - Armando Vergara-Martel
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, United States of America
| | - Luis Augusto Palma Dallan
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, United States of America
| | | | - Elder Zago
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, United States of America
| | - Vladislav Zimin
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, United States of America
| | - Hiram Grando Bezerra
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, United States of America
| |
Collapse
|
41
|
Hakeem A, Uretsky BF. Toward a "More Perfect" Interventional Algorithm: Post-Intervention Functional Assessment Using Quantitative Flow Ratio. JACC Cardiovasc Interv 2019; 12:2076-2078. [PMID: 31563679 DOI: 10.1016/j.jcin.2019.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Abdul Hakeem
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
| | - Barry F Uretsky
- Division of Cardiology, Central Arkansas VA Medical Center, Little Rock, Arkansas
| |
Collapse
|
42
|
Hakeem A, Ghosh B, Shah K, Agarwal S, Kasula S, Hacioglu Y, Bhatti S, Ahmed Z, Uretsky B. Incremental Prognostic Value of Post-Intervention Pd/Pa in Patients Undergoing Ischemia-Driven Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:2002-2014. [DOI: 10.1016/j.jcin.2019.07.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 01/10/2023]
|
43
|
Kogame N, Takahashi K, Tomaniak M, Chichareon P, Modolo R, Chang CC, Komiyama H, Katagiri Y, Asano T, Stables R, Fath-Ordoubadi F, Walsh S, Sabaté M, Davies JE, Piek J, van Geuns RJ, Reiber JH, Banning AP, Escaned J, Farooq V, Serruys PW, Onuma Y. Clinical Implication of Quantitative Flow Ratio After Percutaneous Coronary Intervention for 3-Vessel Disease. JACC Cardiovasc Interv 2019; 12:2064-2075. [DOI: 10.1016/j.jcin.2019.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 10/25/2022]
|
44
|
Blinded Physiological Assessment of Residual Ischemia After Successful Angiographic Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:1991-2001. [DOI: 10.1016/j.jcin.2019.05.054] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 01/10/2023]
|