Circulation: Cardiovascular Interventions最新文献

{"title":"Clinical Impact of Physiology-Guided PCI: 1-year Results of the Post-Revascularization Optimization and Physiological Evaluation of Intermediate Lesions using Fractional Flow Reserve (PROPHET-FFR) Study.","authors":"Domenico Galante, Andrea Vicerè, Simona Todisco, Stefano Migliaro, Giuseppe Zimbardo, Pio Cialdella, Chiara Giuliana, Vincenzo Viccaro, Ciro Pollio Benvenuto, Leonardo Calò, Mattia Lunardi, Lazzaro Paraggio, Antonino Buffon, Francesco Fracassi, Cristina Aurigemma, Enrico Romagnoli, Gianluca Campo, Simone Biscaglia, Carlo Trani, Francesco Burzotta, Antonio Maria Leone","doi":"10.1161/CIRCINTERVENTIONS.126.017446","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.017446","url":null,"abstract":"<p><p><b>Background:</b> The clinical value of physiological assessment after percutaneous coronary intervention (PCI) remains uncertain. We evaluated clinical outcomes associated with post-PCI physiology and temporal trends in its adoption. <b>Methods:</b> PROPHET-FFR (NCT05056662) is an ambispective observational study of patients undergoing invasive physiological assessment of intermediate coronary stenoses. Patients were categorized into three strategies: deferred revascularization based on non-ischemic physiology (deferred PCI), PCI for ischemic lesions without post-PCI physiological assessment (conventional PCI), and physiology-guided PCI with post-PCI assessment and optimization when indicated (post-PCI physiology). Temporal trends in the use of post-PCI physiology and physiology-guided optimization were evaluated, together with the incidence of 12-month major adverse cardiovascular events (MACE), comprising cardiovascular death, spontaneous myocardial infarction, and target-vessel revascularization (TVR). Propensity score matching between conventional PCI and post-PCI physiology was performed to confirm the primary findings. <b>Results:</b> Among 1,986 patients, 1,307 underwent deferred PCI, 331 conventional PCI, and 348 post-PCI physiology. At 12 months, MACE occurred in 4.1%, 7.6%, and 3.4%, respectively (p=0.011). Compared with conventional-PCI, post-PCI physiology had lower MACE (3.4% vs 7.6%; p=0.019), primarily driven by reduced TVR (2.6% vs 5.4%; p=0.057), with consistent findings after propensity score matching (226 patients/group; 2.7% vs 8.0%; p=0.0114). Post-PCI physiology increased from 11.8% to 22.8% across registry phases (p<0.001), with a numerical increase in physiology-guided optimization (11.6% vs 18.1%; p=0.08). <b>Conclusions:</b> In this observational study, post-PCI physiology appears to be associated with lower 12-month MACE compared with conventional PCI, with consistent findings after propensity score matching.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification and Outcomes of Coronary Microvascular Disease in Myocardial Infarction and Angina With Nonobstructive Coronary Arteries.","authors":"Justin G Carrington, Kai Nogami, Yoshihisa Kanaji, Brad R Lewis, Amr O Moustafa, Rajiv Gulati, Marysia S Tweet, Vassilis Vassiliou, Abhiram Prasad, Amir Lerman, Claire E Raphael","doi":"10.1161/CIRCINTERVENTIONS.126.016552","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016552","url":null,"abstract":"<p><strong>Background: </strong>Myocardial infarction with nonobstructive coronary arteries (MINOCAs) and angina with nonobstructive coronary arteries (ANOCAs) present diagnostic and therapeutic challenges. We assessed the frequency of coronary microvascular disease (CMD) and its subtypes in MINOCA compared with ANOCA and evaluated long-term cardiovascular outcomes.</p><p><strong>Methods: </strong>Patients with nonobstructive coronary arteries undergoing invasive coronary function testing from 2012 to 2022 were prospectively enrolled and retrospectively classified as MINOCA or ANOCA (reference group). Myocardial infarction due to atherothrombosis, myocarditis, and Takotsubo syndrome were excluded. Invasive provocation testing was performed. CMD was classified as endothelium-independent (coronary flow reserve <2.5 with adenosine) and endothelium-dependent (<50% increase in coronary blood flow with acetylcholine). Major adverse cardiovascular events (cardiac death, nonfatal myocardial infarction, heart failure hospitalization, urgent revascularization, stroke) were recorded over 8 years.</p><p><strong>Results: </strong>Of 622 patients, 73 (12%) had MINOCA (69% female, median age 56 years) and 549 (88%) ANOCA (72% female, median age 53 years). CMD was common in both groups (71% versus 64%; <i>P</i>=0.271), while endothelium-independent CMD was more frequent in MINOCA (41% versus 21%; <i>P</i><0.001). Over a median follow-up of 4.5 years, major adverse cardiovascular events occurred more often in MINOCA (40% versus 11%; adjusted hazard ratio, 2.4; <i>P</i>=0.001). CMD predicted higher major adverse cardiovascular events in both MINOCA (hazard ratio, 3.6 [95% CI, 1.1-12.0]; <i>P</i>=0.038) and ANOCA (hazard ratio, 7.9 [95% CI, 2.9-21.8]; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>CMD is common in both MINOCA and ANOCA. The higher prevalence of endothelium-independent CMD in MINOCA suggests a potential mechanistic role in infarction. Patients with MINOCA have a worse prognosis than ANOCA, particularly when CMD is present.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016552"},"PeriodicalIF":7.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter by Koliastasis and Kim Regarding Article, \"Impact of Coronary Diameter Stenosis and Proximal Lesion Location on Outcomes Following PCI in Patients Undergoing TAVI: Prespecified NOTION-3 Substudy\".","authors":"Leonidas Koliastasis, Won-Keun Kim","doi":"10.1161/CIRCINTERVENTIONS.126.017463","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.017463","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e017463"},"PeriodicalIF":7.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response by Riihiniemi et al to Letter Regarding Article, \"Impact of Coronary Diameter Stenosis and Proximal Lesion Location on Outcomes Following PCI in Patients Undergoing TAVI: Prespecified NOTION-3 Substudy\".","authors":"Matti Riihiniemi, Jarkko Piuhola, Jacob Lønborg","doi":"10.1161/CIRCINTERVENTIONS.126.017497","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.017497","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e017497"},"PeriodicalIF":7.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Stent Restenosis in Transition: Interpreting the Rise of Adjunctive Therapy.","authors":"Mirvat Alasnag, Anas Noman","doi":"10.1161/CIRCINTERVENTIONS.126.017464","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.017464","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e017464"},"PeriodicalIF":7.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Potency P2Y12 Inhibitors Among Patients With Chronic Coronary Syndrome Undergoing PCI: An Analysis From the NCDR CathPCI Registry.","authors":"Ayman R Fath, Jennifer Rymer, Angel Marks, Daniel Wojdyla, Ian C Gilchrist, Yader Sandoval, Binita Shah, Emmanouil Brilakis, Sunil V Rao, Islam Y Elgendy","doi":"10.1161/CIRCINTERVENTIONS.126.016658","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016658","url":null,"abstract":"<p><strong>Background: </strong>Clinical practice guidelines recommend the use of clopidogrel among patients with chronic coronary syndrome undergoing percutaneous coronary intervention. The frequency of high-potency P2Y12 inhibitors, such as ticagrelor or prasugrel, in this setting is not well known.</p><p><strong>Methods: </strong>Using the National Cardiovascular Data Registry CathPCI registry, we analyzed patients with chronic coronary syndrome undergoing percutaneous coronary intervention from April 2018 to June 2024, excluding those discharged on oral anticoagulants. Temporal trends in high-potency P2Y12 inhibitor prescription were examined. A mixed-effects multivariable logistic regression model with a random intercept for hospital was used to identify patient-, procedural-, and institutional-level factors associated with high-potency P2Y12 inhibitor prescription while accounting for within-hospital clustering. Between-hospital variation was quantified using the median odds ratio.</p><p><strong>Results: </strong>Among 783 977 patients across 1815 hospitals, 35% were prescribed a high-potency P2Y12 inhibitor at discharge. The use of high-potency P2Y12 inhibitors declined from 35% in 2018 to 31% in 2024 (<i>P</i>-trend=0.019), driven by a reduction in ticagrelor (from 29% to 23%, <i>P</i>-trend <0.001) despite a modest increase in prasugrel use (from 6.2% to 8%, <i>P</i>-trend=0.10). Male sex, prior myocardial infarction, and markers of procedural complexity (high-complexity/type C lesions, left main coronary artery, proximal left anterior descending artery, or use of mechanical circulatory support) were associated with higher odds of high-potency P2Y12 inhibitor prescription. In contrast, older age (≥75 years), prior stroke/transient ischemic attack, prior coronary artery bypass graft, severe renal dysfunction, and chronic total occlusion were associated with lower odds. University hospitals had lower odds of prescribing high-potency P2Y12 inhibitors, with considerable variability in prescription patterns among institutions (median odds ratio, 2.59).</p><p><strong>Conclusions: </strong>Nearly one-third of chronic coronary syndrome patients undergoing percutaneous coronary intervention were discharged on high-potency P2Y12 inhibitors, with decreasing trends over time. Practice patterns reflected perceived ischemic versus bleeding risk and significant institutional variation, underscoring opportunities for quality improvement and guideline alignment.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016658"},"PeriodicalIF":7.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Drug-Coated Versus Conventional Balloons for the Side Branches of Bifurcation Lesions: OCVC-BIF Study.","authors":"Takayuki Ishihara, Tomoharu Dohi, Daisuke Sakamoto, Hirota Kida, Naotaka Okamoto, Atsushi Kikuchi, Tsutomu Kawai, Naoki Mori, Ryu Shutta, Minoru Ichikawa, Yasunori Ueda, Daisuke Nakamura, Toshiaki Mano, Masami Nishino, Tetsuya Watanabe, Yoshiharu Higuchi, Eisuke Hida, Tomoharu Sato, Shungo Hikoso, Daisaku Nakatani, Yohei Sotomi, Yasushi Sakata","doi":"10.1161/CIRCINTERVENTIONS.125.016424","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.016424","url":null,"abstract":"<p><strong>Background: </strong>Coronary bifurcation lesions remain one of the most challenging lesions. In particular, satisfactory clinical outcomes have not yet been achieved for side branches. The use of drug-coated balloons (DCBs) has demonstrated acceptable clinical outcomes in native coronary arteries. This study aimed to evaluate the efficacy and safety of additional DCB inflation in the side branches of bifurcation lesions.</p><p><strong>Methods: </strong>The OCVC-BIF study (Comparison of Drug-Coated Versus Conventional Balloons for the Side Branch of Bifurcation Lesions) was conducted as a multicenter, randomized, open-label trial. Patients with bifurcation lesions scheduled for drug-eluting stent (DES) implantation in the main vessel followed by kissing balloon inflation were enrolled in the study. The patients were randomized to receive either additional dilatation of the side branch using a DCB after DES implantation with kissing balloon inflation (DCB group) or only DES implantation with kissing balloon inflation using conventional balloons (non-DCB group). The primary end point was restenosis of the side branch, assessed using scheduled coronary angiography at 9 months or symptom-driven coronary angiography during the 1-year follow-up. Restenosis was defined as ≥50% stenosis of the side branch, determined using 3-dimensional bifurcation quantitative coronary angiography. The key secondary end points included major adverse cardiac events at 12 months, which were defined as a composite of cardiac death, myocardial infarction, clinically driven target lesion revascularization, and stent thrombosis.</p><p><strong>Results: </strong>In total, 299 patients were randomized into the DCB (151 patients) and non-DCB (148 patients) groups between October 2019 and September 2024. Serial 3-dimensional bifurcation quantitative coronary angiography evaluation was performed in 262 (87.6%) patients. The restenosis rate was lower in the DCB group than that in the non-DCB group (8.1% versus 18.3%, <i>P</i>=0.012). However, the incidence of major adverse cardiac events at 12 months was similar between them (10.1% versus 12.4%, <i>P</i>=0.58).</p><p><strong>Conclusions: </strong>Additional DCB inflation in the side branch after main-vessel DES implantation with kissing balloon inflation decreases restenosis in the side branch in the treatment of bifurcation lesions.</p><p><strong>Registration: </strong>URL: https://jrct.mhlw.go.jp/en-latest-detail/jRCTs052200077; Unique identifier: jRCTs052200077.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"19 10","pages":"e016424"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-Coated Balloons for Side-Branch Treatment in Coronary Bifurcations: Ready for Prime Time?","authors":"Arman Qamar, Binita Shah","doi":"10.1161/CIRCINTERVENTIONS.126.017233","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.017233","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e017233"},"PeriodicalIF":7.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paclitaxel-Coated Devices in Patients With Chronic Limb-Threatening Ischemia and Tissue Loss Undergoing Infrainguinal Endovascular Revascularization: Insights From the SWEDEPAD-1 Trial.","authors":"Fredrik Sellgren, Mårten Falkenberg, Manne Andersson, Mattias Andersson, Tom Le Corvec, Martin Delle, Jan Engström, Torbjörn Fransson, Anna Hilbertson, Tal M Hörer, Eva Jacobsson, Stefan James, Björn Kragsterman, Johan Lindbäck, Hans Lindgren, Stefan Mellander, Robert Olin, Birgitta Sigvant, Per Skoog, Christian Smedberg, Joachim Starck, Gustaf Tegler, Knut Thorbjørnsen, Maria Truedson, Per Törnqvist, Carl-Magnus Wahlgren, Jonas Wallinder, Andreas Öjersjö, Joakim Nordanstig","doi":"10.1161/CIRCINTERVENTIONS.126.016977","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016977","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic limb-threatening ischemia and tissue loss (Rutherford 5-6) are at high risk of major amputation. Drug-coated technologies are effective in coronary interventions, but their impact on limb outcomes in advanced ischemia remains uncertain. We evaluated whether drug-coated devices improve limb salvage in this high-risk population.</p><p><strong>Methods: </strong>This post hoc subgroup analysis used data from SWEDEPAD-1 (Swedish Drug-Elution Trial in Peripheral Arterial Disease), a multicenter registry-based randomized controlled trial of endovascular treatment for infrainguinal arterial disease. Adults with chronic limb-threatening ischemia were randomized 1:1 to treatment with paclitaxel-coated or uncoated endovascular devices. Only patients with tissue loss (Rutherford 5 or 6) were included. The primary end point was time to ipsilateral major amputation. Secondary end points were target vessel reintervention and a composite of major amputation or target vessel reintervention. Outcomes were assessed at 3 months, 1 year, and 5 years using intention-to-treat analyses and adjusted Cox proportional hazards models.</p><p><strong>Results: </strong>Among 1761 patients (median age, 77 years; 60.1% male; 58.4% diabetes), ipsilateral major amputation within 3 months was more frequent in the paclitaxel-coated group than in the uncoated group (10.4% versus 7.5%; adjusted hazard ratio, 1.43 [95% CI, 1.04-1.96]). Amputation rates were similar at 1 year (16.3% versus 14.6%) and remained comparable through 5 years. Target vessel reintervention at 1 year was lower with paclitaxel-coated devices (13.6% versus 18.0%; adjusted hazard ratio, 0.77 [95% CI, 0.61-0.97]), but this difference was attenuated when early limb loss was included in a composite end point. No significant between-group differences were observed at 5 years.</p><p><strong>Conclusions: </strong>In patients with chronic limb-threatening ischemia and tissue loss, paclitaxel-coated devices did not improve limb salvage and were associated with a higher early risk of major amputation. Although target vessel reintervention was reduced at 1 year, this apparent benefit was not maintained when accounting for the competing risk of limb loss in a composite end point.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02051088.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016977"},"PeriodicalIF":7.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrasting Prognostic Value of Discordance Between Resting Distal-to-Aortic Coronary Pressure Ratio and Fractional Flow Reserve in Coronary Artery Disease.","authors":"So-Min Lim, Jung-Min Ahn, Do-Yoon Kang, Eun-Seok Shin, Bon-Kwon Koo, Chang Wook Nam, Hanbit Park, Bong-Ki Lee, Jin Bae Lee, Seong-Bong Wee, Ha Hye Jo, Joong Min Lee, Young-Sun Park, Ju Hyeon Kim, Hwa Jung Kim, Duk-Woo Park, Seung-Jung Park","doi":"10.1161/CIRCINTERVENTIONS.126.016865","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016865","url":null,"abstract":"<p><strong>Background: </strong>Discordance between nonhyperemic pressure ratios and fractional flow reserve (FFR), observed in up to 20% of cases, complicates clinical decision-making for coronary revascularization and warrants further investigation of its clinical implications. This study aimed to evaluate the outcomes of medically managed discordant lesions between FFR and the resting whole-cycle distal-to-aortic coronary pressure ratio (Pd/Pa).</p><p><strong>Methods: </strong>From the prospective IRIS-FFR registry (Interventional Cardiology Research In-Cooperation Society Fractional Flow Reserve), 9737 lesions in 7376 patients treated medically were analyzed. The lesions were grouped based on resting Pd/Pa (≤0.93) and FFR (≤0.80) values. The primary outcome was 5-year target-vessel failure, including target-vessel myocardial infarction and target-vessel revascularization, with death from any cause considered as a competing risk. The key secondary outcome was death from any cause.</p><p><strong>Results: </strong>Discordance between resting Pd/Pa and FFR was present in 15.91% of lesions treated medically (n=1549). Lesions with resting Pd/Pa >0.93 and FFR ≤0.80 had a higher risk of target-vessel failure than those with resting Pd/Pa ≤0.93 and FFR >0.80 (adjusted hazard ratio, 1.67 [95% CI, 1.09-2.55]; <i>P</i>=0.020) but a lower risk of all-cause death (adjusted hazard ratio, 0.23 [95% CI, 0.11-0.52]; <i>P</i><0.001). The reduction in target-vessel failure with revascularization was observed only in the group with resting Pd/Pa >0.93 and FFR ≤0.80.</p><p><strong>Conclusions: </strong>FFR predicts vessel-specific coronary events, whereas resting Pd/Pa is associated with overall survival. The contrasting prognostic value of discordant lesions underscores the clinical importance of a complementary assessment using both resting and hyperemic coronary physiological indices.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01366404.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016865"},"PeriodicalIF":7.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}