Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes
Abstract Diffuse coronary artery disease (CAD) impacts the immediate hemodynamic and clinical outcomes of percutaneous coronary intervention (PCI). We evaluated whether the diffuse pattern of CAD derived from angiographic Quantitative flow ratio (QFR) impacts the immediate hemodynamic outcome post-P...
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Nature Portfolio
2025-01-01
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| Online Access: | https://doi.org/10.1038/s41598-025-85872-9 |
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| author | Shigetaka Kageyama Pruthvi Chenniganahosahalli Revaiah Tsai Tsung-Ying Kotaro Miyashita Akihiro Tobe Neil O’Leary Johan H. C. Reiber Shengxian Tu Azfar Zaman Manel Sabaté Helge Möllmann Faisal Sharif Julien Lemoine Adrian Wlodarczak Scot Garg Yoshinobu Onuma Patrick W. Serruys |
| author_facet | Shigetaka Kageyama Pruthvi Chenniganahosahalli Revaiah Tsai Tsung-Ying Kotaro Miyashita Akihiro Tobe Neil O’Leary Johan H. C. Reiber Shengxian Tu Azfar Zaman Manel Sabaté Helge Möllmann Faisal Sharif Julien Lemoine Adrian Wlodarczak Scot Garg Yoshinobu Onuma Patrick W. Serruys |
| author_sort | Shigetaka Kageyama |
| collection | DOAJ |
| description | Abstract Diffuse coronary artery disease (CAD) impacts the immediate hemodynamic and clinical outcomes of percutaneous coronary intervention (PCI). We evaluated whether the diffuse pattern of CAD derived from angiographic Quantitative flow ratio (QFR) impacts the immediate hemodynamic outcome post-PCI and the medium term predicted vessel-oriented composite endpoint (VOCE). Paired pre-procedure QFRs were assessed in 503 patients and 1022 vessels in the Multivessel TALENT (MVT) trial. The pathophysiological pattern of CAD was defined as “predominantly diffuse” or “focal” according to a virtual QFR pullback pressure gradient (PPG) index < 0.78 and ≥ 0.78, respectively. Physiological “focal severity” was assessed using the QFR gradient per mm (dQFR/ds), with a value ≥ 0.025/mm the threshold for a “major gradient”. A post-PCI QFR ≥ 0.91 was considered optimal. Median pre-PCI PPG index was 0.70 (IQR 0.59–0.80). The prevalence of “predominantly diffuse” CAD and “major gradient” were 68.6% and 85.8%, respectively. A “Predominantly diffuse” pattern with a major gradient had a higher risk of a post-PCI QFR < 0.91 (OR 1.52,95%CI 1.47–1.58). In multivariable analysis, low QFR PPG index (diffuse disease) was an independent determinant of a post-PCI QFR < 0.91 (per 0.1 decrease of QFR PPG index, OR:9.8, 95% CI 3.0–32.2, p < 0.001). Based on post-PCI QFR the predicted 2-year VOCE, a powered endpoint in the MVT trial, was 6.1% and 4.2% in diffuse and focal lesions, respectively. A pre-procedure physiological pattern of diffuse CAD is an independent determinant of an unfavourable immediate hemodynamic outcome post-PCI, and detrimentally affects the predicted 2-year VOCE. Clinical Trial Registration URL: https://www.clinicaltrials.gov/ct2/show/NCT04390672 Unique Identifier: NCT04390672 (registration date 15/05/2020) |
| format | Article |
| id | doaj-art-8e08b3c7f73d4d299300bcbe8e531a46 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Nature Portfolio |
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| spelling | doaj-art-8e08b3c7f73d4d299300bcbe8e531a462025-01-19T12:22:39ZengNature PortfolioScientific Reports2045-23222025-01-0115111110.1038/s41598-025-85872-9Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomesShigetaka Kageyama0Pruthvi Chenniganahosahalli Revaiah1Tsai Tsung-Ying2Kotaro Miyashita3Akihiro Tobe4Neil O’Leary5Johan H. C. Reiber6Shengxian Tu7Azfar Zaman8Manel Sabaté9Helge Möllmann10Faisal Sharif11Julien Lemoine12Adrian Wlodarczak13Scot Garg14Yoshinobu Onuma15Patrick W. Serruys16Department of Cardiology, University of GalwayDepartment of Cardiology, University of GalwayDepartment of Cardiology, University of GalwayDepartment of Cardiology, University of GalwayDepartment of Cardiology, University of GalwaySchool of Mathematical and Statistical SciencesMedis Medical Imaging SystemsSchool of Biomedical Engineering, Shanghai Jiao Tong UniversityDepartment of Cardiology, Freeman Hospital and Faculty of Medical Sciences, Newcastle UniversityDepartment of Cardiology, Clinic HospitalDepartment of Cardiology, St. Johannes HospitalDepartment of Cardiology, University of GalwayDepartment of Cardiology, Clinique Louis PasteurDepartment of Cardiology, The Copper Health Centre (MCZ)Department of Cardiology, Royal Blackburn HospitalDepartment of Cardiology, University of GalwayDepartment of Cardiology, University of GalwayAbstract Diffuse coronary artery disease (CAD) impacts the immediate hemodynamic and clinical outcomes of percutaneous coronary intervention (PCI). We evaluated whether the diffuse pattern of CAD derived from angiographic Quantitative flow ratio (QFR) impacts the immediate hemodynamic outcome post-PCI and the medium term predicted vessel-oriented composite endpoint (VOCE). Paired pre-procedure QFRs were assessed in 503 patients and 1022 vessels in the Multivessel TALENT (MVT) trial. The pathophysiological pattern of CAD was defined as “predominantly diffuse” or “focal” according to a virtual QFR pullback pressure gradient (PPG) index < 0.78 and ≥ 0.78, respectively. Physiological “focal severity” was assessed using the QFR gradient per mm (dQFR/ds), with a value ≥ 0.025/mm the threshold for a “major gradient”. A post-PCI QFR ≥ 0.91 was considered optimal. Median pre-PCI PPG index was 0.70 (IQR 0.59–0.80). The prevalence of “predominantly diffuse” CAD and “major gradient” were 68.6% and 85.8%, respectively. A “Predominantly diffuse” pattern with a major gradient had a higher risk of a post-PCI QFR < 0.91 (OR 1.52,95%CI 1.47–1.58). In multivariable analysis, low QFR PPG index (diffuse disease) was an independent determinant of a post-PCI QFR < 0.91 (per 0.1 decrease of QFR PPG index, OR:9.8, 95% CI 3.0–32.2, p < 0.001). Based on post-PCI QFR the predicted 2-year VOCE, a powered endpoint in the MVT trial, was 6.1% and 4.2% in diffuse and focal lesions, respectively. A pre-procedure physiological pattern of diffuse CAD is an independent determinant of an unfavourable immediate hemodynamic outcome post-PCI, and detrimentally affects the predicted 2-year VOCE. Clinical Trial Registration URL: https://www.clinicaltrials.gov/ct2/show/NCT04390672 Unique Identifier: NCT04390672 (registration date 15/05/2020)https://doi.org/10.1038/s41598-025-85872-9Coronary artery diseaseDisease patternPercutaneous coronary interventionQuantitative flow ratioChronic coronary syndromeAcute coronary syndrome |
| spellingShingle | Shigetaka Kageyama Pruthvi Chenniganahosahalli Revaiah Tsai Tsung-Ying Kotaro Miyashita Akihiro Tobe Neil O’Leary Johan H. C. Reiber Shengxian Tu Azfar Zaman Manel Sabaté Helge Möllmann Faisal Sharif Julien Lemoine Adrian Wlodarczak Scot Garg Yoshinobu Onuma Patrick W. Serruys Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes Scientific Reports Coronary artery disease Disease pattern Percutaneous coronary intervention Quantitative flow ratio Chronic coronary syndrome Acute coronary syndrome |
| title | Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes |
| title_full | Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes |
| title_fullStr | Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes |
| title_full_unstemmed | Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes |
| title_short | Diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes |
| title_sort | diffuseness of coronary artery disease impacts on immediate hemodynamic and predicted clinical outcomes |
| topic | Coronary artery disease Disease pattern Percutaneous coronary intervention Quantitative flow ratio Chronic coronary syndrome Acute coronary syndrome |
| url | https://doi.org/10.1038/s41598-025-85872-9 |
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