Post PCI Diastolic Pressure Ratio May Predict Risk Of Adverse Cardiac Events
An increasing body of evidence supports the use of either fractional flow reserve (FFR) or the non-hyperaemic instantaneous wave-free ratio (iFR) for intracoronary physiological assessment of intermediate coronary artery lesions. A recent study suggests that the incidence of target vessel failure (TVF) was higher in patients with post-PCI dPR ≤ 0.8. The study findings were published in the Netherlands Heart Journal on April 07, 2022.
To date, limited data are available on the distribution of NHPRs and their prognostic value. post-percutaneous coronary intervention non-hyperaemic pressure ratios (post-PCI NHPRs). Therefore, Dr J. Daemen and his team conducted a study to evaluate the distribution of a recently validated generic diastolic pressure ratio (dPR) after angiographically successful PCI in an all-comers study population and to study its association with 2-year clinical outcome.
The dPR SEARCH study was a post hoc analysis of the FFR-SEARCH registry, a prospective single-centre registry in which the researchers performed routine FFR measurements after angiographically successful PCI in a total of 1000 patients between March 2016 and May 2017. They further calculated dRP offline with recently validated software in a subset of 735 patients.
Key findings of the study:
- Upon analysis, the researchers observed that the mean post-PCI dPR was 0.95 ± 0.06.
- They found that the post-PCI dPR was ≤ 0.89 in 15.2% of the patients.
- They noted that the cumulative incidence of TVF at 2-year follow-up was 9.4% in patients with a final post-PCI dPR ≤ 0.89 as compared to 6.1% in patients with a post-PCI dPR > 0.89 (adjusted hazard ratio [HR] for dPR ≤ 0.89: 1.53).
- They reported that dPR ≤ 0.89 was associated with significantly higher cardiac mortality at 2 years; adjusted HR 2.40.
The authors concluded, "Despite optimal angiographic PCI results, 15.2% of the patients had a final post-PCI dPR of ≤ 0.89, which was associated with a significantly higher cardiac mortality rate. The incidence of TVF was higher in patients with post-PCI dPR ≤ 0.89."
For further information:
DOI: https://doi.org/10.1007/s12471-022-01680-0
Keywords:
Fractional flow reserve, target vessel failure, post-percutaneous coronary intervention, non-hyperaemic pressure ratios, diastolic pressure ratio, FFR-SEARCH registry, dPR SEARCH study, post-PCI dPR, Netherlands Heart Journal.
