Changes in fractional flow reserve (FFR) values after percutaneous coronary intervention (PCI) are associated with improvement in angina symptoms. The pattern of baseline coronary artery disease influences the degree of variation in FFR after stent implantation.
Focal coronary artery disease leads to high post-PCI FFR values, while the improvement is not as marked in diffuse coronary artery disease. Baseline pattern of coronary disease can anticipate the likelihood of successful improvement in angina symptoms. However, the definition of diffuse disease has not been standardized and is often based on visual assessment, limiting its accuracy and repeatability.
Using the pullback pressure gradient (PPG) of the FFR, the aim of this subanalysis of the randomized, prospective, single-center study TARGET-FFR (Trial of Angiography vs. pressure-Ratio-Guided Enhancement Techniques-Fractional Flow Reserve) was to investigate the differential effect on patient-reported outcomes of PCI on focal (PPG ≥0.66) and diffuse (PPG <0.66) disease.
The endpoints were questionnaires to assess the presence of angina and patient quality of life.
A total of 103 patients were analyzed: 51 had focal disease and 52 had diffuse disease. There were no differences in baseline characteristics between the two groups. The mean PPG was 0.66. Patients with focal disease were treated with fewer (p = 0.022) and shorter (p = 0.015) stents. In addition, this population had higher post-PCI FFR values (p < 0.001) and greater change was observed after intervention (p < 0.001).
After PCI, almost 40% of patients experienced residual angina, which was significantly lower in patients with focal disease compared with diffuse disease (27.5% vs. 51.9%, respectively; p = 0.020). In addition, patients with focal coronary artery disease reported less angina, less physical limitation, and better quality of life.
On the other hand, after PCI, patients with focal disease experienced increased mobility and self-care, and decreased pain and discomfort. There were no differences in the presence of anxiety and/or depression between both groups.
Conclusion
Residual angina after PCI was frequent and found in patients with diffuse coronary disease defined as pre-PCI PPG. After PCI, patients with focal disease experienced angina improvement and better quality of life. PPG was useful to identify patients who would benefit from percutaneous revascularization in terms of symptomatic improvement.
Dr. Andrés Rodríguez.
Member of the editorial board of SOLACI.org.
Reference: Carlos Collet, MD, PHD et al J Am Coll Cardiol Intv 2022.
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