Taito Arai, Koshiro Sakai, Kazumasa Ikeda, Takuya Mizukami, Frédéric Bouisset, Han Zhang, Mitsuaki Matsumura, Jeroen Sonck, Adriaan Wilgenhof, Hitoshi Matsuo, Tetsuya Amano, Hirohiko Ando, Masahiro Hada, Brian Ko, Simone Biscaglia, Fernando Rivero, Thomas Engstrøm, Antonio Maria Leone, Lokien X van Nunen, William F Fearon, Evald Høj Christiansen, Stephane Fournier, Liyew Desta, Andy Yong, Julien Adjedj, Javier Escaned, Masafumi Nakayama, Ashkan Eftekhari, Danielle Keulards, Frederik M Zimmermann, Ethan Korngold, Daniel Munhoz, Gianluca Campo, Colin Berry, Damien Collison, Thomas W Johnson, Divaka Perera, Allen Jeremias, Ziad Ali, Bernard De Bruyne, Gary S Mintz, Nils Johnson, Toshiro Shinke, Carlos Collet
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引用次数: 0
Abstract
Background: Intravascular imaging (IVI) during percutaneous coronary intervention (PCI) improves outcomes. Pullback pressure gradient (PPG) characterizes coronary artery disease patterns as focal or diffuse; however, the benefit of IVI across this spectrum remains incompletely understood. We aimed to evaluate clinical outcomes after PCI with or without IVI guidance in patients with focal and diffuse disease defined by PPG.
Methods: Prospective, multicenter, single-arm study of 811 patients (840 vessels) undergoing PCI. PPG was calculated from manual fractional flow reserve pullbacks to define focal (PPG ≥0.62) or diffuse coronary artery disease. IVI use was at the operator's discretion. The primary outcome was target vessel failure at 1-year follow-up.
Results: IVI-guided PCI was performed in 41% of patients. In the overall cohort, target vessel failure was lower with IVI guidance (adjusted hazard ratio, 0.60 [95% CI 0.36-0.99]; P=0.044), with a lower incidence of cardiac death (P=0.042). IVI significantly reduced target vessel failure in focal disease (unadjusted HR, 0.41 [95% CI, 0.18-0.91]; P=0.029), whereas no difference was observed in diffuse disease (unadjusted HR, 0.91 [95% CI, 0.48-1.73]; P=0.771). There was no interaction between PPG and IVI guidance for target vessel failure (P for interaction=0.128).
Conclusions: In patients undergoing physiology-guided PCI, the use of IVI reduced clinical events at 1 year. These findings suggest that the benefit of IVI extends across the full spectrum of coronary artery disease.
期刊介绍：
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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