Impact of trans-stent gradient on outcome after PCI: results from a HAWKEYE substudy

The International Journal of Cardiovascular Imaging - Tập 38 Số 12 - Trang 2819-2827
Andrea Erriquez1, Barry F. Uretsky2, Salvatore Brugaletta3, Giosafat Spitaleri3, Enrico Cerrato4, Giorgio Quadri4, Marco Manfrini5, Graziella Pompei1, Davide Scancarello1, Michele Trichilo1, Federico Marchini1, Serena Caglioni1, Roberta Campana1, Andrea Marrone1, Carlo Penzo1, Carlo Tumscitz1, Matteo Tebaldi1, Filippo Maria Verardi1, Antonella Scala1, Gianluca Campo1, Simone Biscaglia1
1Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, S. Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy
2Central Arkansas VA Health System, Little Rock, AR, USA
3Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University Hospital Clínic, Barcelona, Spain
4San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli, Turin, Italy
5Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy

Tóm tắt

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).

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Brugaletta S, Gomez-Lara J, Ortega-Paz L et al (2021) 10-year follow-up of patients with everolimus-eluting versus bare-metal stents after ST-segment elevation myocardial infarction. J Am Coll Cardiol 77(9):1165–1178. https://doi.org/10.1016/J.JACC.2020.12.059

Pavasini R, Biscaglia S, Barbato E et al (2022) Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials. Eur Heart J. https://doi.org/10.1093/eurheartj/ehz896

Sabaté M, Brugaletta S, Cequier A et al (2016) Clinical outcomes in patients with ST-segment elevation myocardial infarction treated with everolimus-eluting stents versus bare-metal stents (EXAMINATION): 5-year results of a randomised trial. The Lancet 387(10016):357–366

von Birgelen C, Zocca P, Buiten RA et al (2018) Thin composite wire strut, durable polymer-coated (Resolute Onyx) versus ultrathin cobalt–chromium strut, bioresorbable polymer-coated (Orsiro) drug-eluting stents in allcomers with coronary artery disease (BIONYX): an international, single-blind, randomi. The Lancet 392(10154):1235–1245

Biscaglia S, Uretsky B, Barbato E et al (2021) Invasive coronary physiology after stent implantation: another step toward precision medicine. Cardiovasc Interv 14(3):237–246

Crea F, Bairey Merz CN et al (2019) Mechanisms and diagnostic evaluation of persistent or recurrent angina following percutaneous coronary revascularization. Eur Heart J 40(29):2455–2462

Biscaglia S, Tebaldi M, Brugaletta S et al (2019) Prognostic value of QFR measured immediately after successful stent implantation: the International Multicenter Prospective HAWKEYE study. Cardiovasc Interv 12(20):2079–2088

Biscaglia S, Uretsky BF, Tebaldi M et al (2021) Angio-based fractional flow reserve, functional pattern of coronary artery disease, and prediction of percutaneous coronary intervention result: a proof-of-concept study. Cardiovasc Drugs Ther. https://doi.org/10.1007/S10557-021-07162-6

van Bommel RJ, Masdjedi K, Diletti R et al (2019) Routine fractional flow reserve measurement after percutaneous coronary Intervention. Circ Cardiovasc Interv 12(5):e007428

Hakeem A, Uretsky BF (2019) Role of postintervention fractional flow reserve to improve procedural and clinical outcomes. Circulation 139(5):694–706

Agarwal SK, Kasula S, Almomani A et al (2014) Clinical and angiographic predictors of persistently ischemic fractional flow reserve after percutaneous revascularization. Am Heart J 2017(184):10–16

Piroth Z, Toth GG, Tonino PAL et al (2017) Prognostic value of fractional flow reserve measured immediately after drug-eluting stent implantation. Circ Cardiovasc Interv 10(8):1–9

Lee JM, Hwang D, Choi KH et al (2018) Prognostic implications of relative increase and final fractional flow reserve in patients with stent implantation. Cardiovasc Interv 11(20):2099–2109

van Zandvoort LJC, Masdjedi K, Witberg K et al (2019) Explanation of postprocedural fractional flow reserve below 08.5: a comprehensive ultrasound analysis of the FFR SEARCH registry. Cardiovasc Interv 12(2):1–10

Fournier S, Ciccarelli G, Toth GG et al (2019) Association of improvement in fractional flow reserve with outcomes, including symptomatic relief, after percutaneous coronary intervention. JAMA Cardiol 4(4):370–374

Tu S, Westra J, Yang J et al (2016) Diagnostic accuracy of fast computational approaches to derive fractional flow reserve from diagnostic coronary angiography: the international multicenter FAVOR pilot study. Cardiovasc Interv 9(19):2024–2035

Westra J, Andersen BK, Campo G et al (2018) Diagnostic performance of in-procedure angiography-derived quantitative flow reserve compared to pressure-derived fractional flow reserve: The FAVOR II Europe-Japan Study. J Am Heart Assoc. https://doi.org/10.1161/JAHA.118.009603

Xu B, Tu S, Song L et al (2021) Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial. The Lancet. https://doi.org/10.1016/S0140-6736(21)02248-0

Katagiri Y, de Maria GL, Kogame N et al (2019) Impact of post-procedural minimal stent area on 2-year clinical outcomes in the SYNTAX II trial. Catheter Cardiovasc Interv 93(4):E225–E234

Sonoda S, Morino Y, Ako J et al (2004) Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the SIRIUS trial. J Am Coll Cardiol 43(11):1959–1963

Fujii K, Carlier SG, Mintz GS et al (2005) Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J Am Coll Cardiol 45(7):995–998

Prati F, Romagnoli E, Burzotta F et al (2015) Clinical impact of OCT findings during PCI the CLI-OPCI II study. Cardiovasc Imaging 8(11):1297–1305

Soeda T, Uemura S, Park SJ et al (2015) Incidence and clinical significance of poststent optical coherence tomography findings: one-year follow-up study from a multicenter registry. Circulation 132(11):1020–1029

Uretsky BF, Agarwal SK, Vallurupalli S et al (2020) Prospective evaluation of the strategy of functionally optimized coronary intervention. J Am Heart Assoc. https://doi.org/10.1161/JAHA.119.015073

Yang H-M, Lim H-S, Yoon M-H et al (2020) Usefulness of the trans-stent fractional flow reserve gradient for predicting clinical outcomes. Catheter Cardiovasc Interv 95(5):E123–E129

Spitaleri G, Tebaldi M, Biscaglia S et al (2018) quantitative flow ratio identifies nonculprit coronary lesions requiring revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease. Cardiovasc Interv. https://doi.org/10.1161/CIRCINTERVENTIONS.117.006023

Cerrato E, Mejía-Rentería H, Franzè A et al (2021) Quantitative flow ratio as a new tool for angiography-based physiological evaluation of coronary artery disease: a review. Future Cardiol. https://doi.org/10.2217/fca-2020-0199

Piroth Z, Toth GG, Tonino PAL et al (2017) Prognostic value of fractional flow reserve measured immediately after drug-eluting stent implantation. Circ Cardiovasc Interv. https://doi.org/10.1161/CIRCINTERVENTIONS.116.005233

Thygesen K, Alpert JS, Jaffe AS et al (2018) Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 72(18):2231–2264

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The International Journal of Cardiovascular Imaging

Tập 38 Số 12

2819-2827

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