Clinical Impact of Concordant and Discordant Physiology Parameters Post-Percutaneous Coronary Intervention in the EASY-PREDICT Study.

Abstract

Background: In the EASY-PREDICT Study, patients were randomized to angiography-guidance or post-percutaneous coronary intervention (PCI) physiology-guidance. Discordance between resting and hyperemic physiology post-PCI might have a different relationship with clinical outcomes.

Aims: The EASY-PREDICT study showed that routine post-PCI physiology assessment was not associated with improved outcomes compared to angiography-guidance only. We aimed to assess whether resting and hyperemic post-PCI physiology had a different clinical impact.

Methods: All-comer patients referred for diagnostic angiography and possible PCI were recruited in a high-volume university hospital and randomized after uncomplicated PCI to angiography-only or target vessel physiology. We studied the concordance and discordance between resting (dPR) and hyperemic (FFR) physiologic parameters post-PCI using ischemic thresholds (dPR ≤ 0.89 and FFR ≤ 0.80) and clinical outcomes up to 18 months post-PCI.

Results: A total of 221 patients (325 lesions) with successful PCI were randomized to either group, 219 of which were included in the per protocol analysis. In the physiology group, 132 lesions with available post-PCI physiology were included and 109 (82.6%) had final concordant physiology results post-PCI. Discordance was observed in 15.15% of lesions, 2.3% FFR ischemic (dPR-|FFR+) and 12.9% dPR ischemic (dPR+|FFR-) respectively. At 18 months clinical follow-up, Target Vessel Failure (TVF) was 12.3% in the concordant sub-group whereas TVF was 40.0% in the discordant subgroup.

Conclusions: After PCI, physiology discordance between dPR and FFR occurred in ~15% of the cases. Patients with discordant physiology results post-PCI appeared to have higher TVF rates compared to concordant physiology sub-groups.