Manesh R Patel1, Allen Jeremias2, Akiko Maehara3, Mitsuaki Matsumura3, Zixuan Zhang3, Joel Schneider4, Kare Tang5, Suneel Talwar6, Koen Marques7, Nicolas W Shammas8, Luis Gruberg9, Arnold Seto10, Habib Samady11, Andrew S P Sharp12, Ziad A Ali13, Gary Mintz3, Justin Davies14, Gregg W Stone15. 1. Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA. Electronic address: manesh.patel@duke.edu. 2. St. Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA. 3. Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA. 4. North Carolina Heart and Vascular, Raleigh, North Carolina, USA. 5. Essex Cardiothoracic Centre, Basildon, United Kingdom. 6. Royal Bournemouth Hospital, Bournemouth, United Kingdom. 7. VU University Medical Center, Amsterdam, the Netherlands. 8. Midwest Cardiovascular Research Foundation, Davenport, Iowa, USA. 9. Northwell Health, New York, USA. 10. Veterans Affairs Medical Center of Long Beach, Long Beach, California, USA. 11. Emory University Hospital, Atlanta, Georgia, USA. 12. University Hospital of Wales, Cardiff, United Kingdom; University of Exeter, Exeter, United Kingdom. 13. St. Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA. 14. Imperial College London, London, United Kingdom. 15. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Abstract
OBJECTIVES: The aim of this study was to identify the post-percutaneous coronary intervention (PCI) target value of instantaneous wave-free ratio (iFR) that would best discriminate clinical events at 1 year in the DEFINE PCI (Physiologic Assessment of Coronary Stenosis Following PCI) study. BACKGROUND: The impact of residual ischemia detected by iFR post-PCI on clinical and symptom-related outcomes is unknown. METHODS: Blinded iFR pull back was performed after successful stent implantation in 500 patients. The primary endpoint was the rate of residual ischemia, defined as iFR ≤0.89, after operator-assessed angiographically successful PCI. Secondary endpoints included clinical events at 1 year and change in Seattle Angina Questionnaire angina frequency (SAQ-AF) score during follow-up. RESULTS: As reported, 24.0% of patients had residual ischemia (iFR ≤0.89) after successful PCI, with 81.6% of cases attributable to angiographically inapparent focal lesions. Post-PCI iFR ≥0.95 (present in 182 cases [39%]) was associated with a significant reduction in the composite of cardiac death, spontaneous myocardial infarction, or clinically driven target vessel revascularization compared with post-PCI iFR <0.95 (1.8% vs 5.7%; P = 0.04). Baseline SAQ-AF score was 73.3 ± 22.8. For highly symptomatic patients (baseline SAQ-AF score ≤60), SAQ-AF score increased by ≥10 points more frequently in patients with versus without post-PCI iFR ≥0.95 (100.0% vs 88.5%; P = 0.01). CONCLUSIONS: In DEFINE PCI, despite angiographically successful PCI, highly symptomatic patients at baseline without residual ischemia by post-PCI iFR had greater reductions in anginal symptoms at 1 year compared with patients with residual ischemia. Achieving post-PCI iFR ≥0.95 was also associated with improved 1-year event-free survival. (Physiologic Assessment of Coronary Stenosis Following PCI [DEFINE PCI]; NCT03084367).
OBJECTIVES: The aim of this study was to identify the post-percutaneous coronary intervention (PCI) target value of instantaneous wave-free ratio (iFR) that would best discriminate clinical events at 1 year in the DEFINE PCI (Physiologic Assessment of Coronary Stenosis Following PCI) study. BACKGROUND: The impact of residual ischemia detected by iFR post-PCI on clinical and symptom-related outcomes is unknown. METHODS: Blinded iFR pull back was performed after successful stent implantation in 500 patients. The primary endpoint was the rate of residual ischemia, defined as iFR ≤0.89, after operator-assessed angiographically successful PCI. Secondary endpoints included clinical events at 1 year and change in Seattle Angina Questionnaire angina frequency (SAQ-AF) score during follow-up. RESULTS: As reported, 24.0% of patients had residual ischemia (iFR ≤0.89) after successful PCI, with 81.6% of cases attributable to angiographically inapparent focal lesions. Post-PCI iFR ≥0.95 (present in 182 cases [39%]) was associated with a significant reduction in the composite of cardiac death, spontaneous myocardial infarction, or clinically driven target vessel revascularization compared with post-PCI iFR <0.95 (1.8% vs 5.7%; P = 0.04). Baseline SAQ-AF score was 73.3 ± 22.8. For highly symptomatic patients (baseline SAQ-AF score ≤60), SAQ-AF score increased by ≥10 points more frequently in patients with versus without post-PCI iFR ≥0.95 (100.0% vs 88.5%; P = 0.01). CONCLUSIONS: In DEFINE PCI, despite angiographically successful PCI, highly symptomatic patients at baseline without residual ischemia by post-PCI iFR had greater reductions in anginal symptoms at 1 year compared with patients with residual ischemia. Achieving post-PCI iFR ≥0.95 was also associated with improved 1-year event-free survival. (Physiologic Assessment of Coronary Stenosis Following PCI [DEFINE PCI]; NCT03084367).
Authors: K Masdjedi; L J C van Zandvoort; T Neleman; I Kardys; J Ligthart; W K Den Dekker; R Diletti; F Zijlstra; N M Van Mieghem; J Daemen Journal: Neth Heart J Date: 2022-04-07 Impact factor: 2.854
Authors: Muhammad Aetesam-Ur-Rahman; Tian X Zhao; Kitty Paques; Joana Oliveira; Bharat Khialani; Stephen Kyranis; Denise M Braganza; Sarah C Clarke; Martin R Bennett; Nick E J West; Stephen P Hoole Journal: J Am Heart Assoc Date: 2022-04-26 Impact factor: 6.106