Clinical Relevance of Impaired Physiological Assessment After Percutaneous Coronary Intervention: A Meta-analysis

Abstract

Background

Despite the optimal angiographic result of percutaneous coronary intervention (PCI), residual disease at the site of the culprit lesion can lead to major adverse cardiac events. Post-PCI physiological assessment can identify residual stenosis. This meta-analysis aims to investigate data of studies examining post-PCI physiological assessment in relation to long-term outcomes.

Methods

Studies were included in the meta-analysis after performing a systematic literature search on July 1, 2022. The primary end point was the incidence of major adverse cardiac events, vessel-orientated cardiac events, or target vessel failure.

Results

Low post-PCI fractional flow reserve, reported in 7 studies with fractional flow reserve cutoff values between 0.84 and 0.90, including 4017 patients, was associated with an increased rate of the primary end point (hazard ratio [HR], 2.06; 95% CI, 1.37-3.08). One study reported about impaired post-PCI instantaneous wave-free ratio with instantaneous wave-free ratio cutoff value of 0.95 in relation to major adverse cardiac events, showing a significant association (HR, 3.38; 95% CI, 0.99-11.6; P = .04). Low post-PCI quantitative flow ratio, reported in 3 studies with quantitative flow ratio cutoff value between 0.89 and 0.91, including 1181 patients, was associated with an increased rate of vessel-orientated cardiac events (HR, 3.01; 95% CI, 2.10-4.32). Combining data of all modalities, impaired physiological assessment showed an increased rate of the primary end point (HR, 2.32; 95% CI, 1.71-3.16) and secondary end points, including death (HR, 1.41; 95% CI, 1.04-1.89), myocardial infarction (HR, 2.70; 95% CI, 1.34-5.42) and target vessel revascularization (HR, 2.88; 95% CI, 1.91-4.35).

Conclusions

Impaired post-PCI physiological assessment is associated with increased adverse cardiac events and individual end points, including death, myocardial infarction, and target vessel revascularization. Therefore, prospective studies are awaited on whether physiology-based optimization of PCI results in better clinical outcomes.

Central Illustration

Post-PCI p hysiological a ssessment and a dverse c ardiac e vents.

Forest plots of hazard ratios (HR) of post-PCI physiological assessment and adverse cardiac events, including MACE, VOCE and TVF, defined according to the included studies. Markers represent point estimates of HRs. Marker size represents study weight. Horizontal bars indicate 95% CIs. FFR, fractional flow reserve; iFR, instantaneous wave-free ratio; MACE, major adverse cardiac events; PCI, percutaneous coronary intervention; QFR, quantitative flow ratio; TVF, target vessel failure; VOCE, vessel-orientated cardiac events.

HIGHLIGHTS

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  Adverse cardiac events are related with impaired physiological assessment.

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  Impaired physiological assessment is related with death, myocardial infarction, and target vessel revascularization.

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  The modality applied for physiological assessment does not influence results.