TCT-726 Impact of the pull back pressure gradient (PPG) on PCI planning and decision-making.

Abstract

Background: Coronary physiology using a distal measurement of fractional flow reserve (FFR) informs about the severity of coronary artery disease (CAD) and, when used for clinical decision making about revascularization, is associated with improved outcomes in patients considered for percutaneous coronary intervention (PCI). A second dimension of coronary physiology is available by performing a pull back maneuver, which aids in assessing the presence and location of focal pressure gradients. Yet, the impact of intracoronary physiology guidance with FFR pull backs on real-time physician decision making during PCI is not fully known. Method(s): This prospective study was performed at 23 sites and enrolled patients with at least 1 epicardial lesion with FFR <=0.80 planned to be treated by PCI. A standardized physiological assessment with FFR pull backs and pull back pressure gradient (PPG) calculation was performed. Treatment plans were recorded for each lesion based on angiography alone and following FFR pull backs. The goal of this study was to assess the procedural impact of physiology guidance in stable patients scheduled for PCI. Optimal PCI outcomes were defined as post-PCI FFR >=0.88. Result(s): Overall, 993 patients (1,044 vessels) underwent complete physiological assessment with FFR and PPG. Following PPG assessment, 50 patients (5%) were deferred to coronary artery bypass grafting, and 88 patients (8.9%) were deferred to optimal medical therapy. Among patients undergoing PCI, the strategy changed in 561 of 889 (63.3%) vessels after PPG. Changes in PCI strategy were more frequent in patients with diffuse CAD compared to those with focal CAD (67.3% vs 60.2%; P = 0.035). The cumulative impact of PPG on the PCI strategy, including pre-PCI and post-PCI assessment, was 73.1% (760/1,036 vessels). Vessels in which the PCI strategy was adapted based on PPG achieved optimal revascularization more frequently (52.5% vs 44.6%; P = 0.045) and showed a trend toward higher final post-PCI FFR compared to those without strategy changes (0.88 +/- 0.07 vs 0.87 +/- 0.07; P = 0.057). Conclusion(s): Incorporating PPG assessment significantly influences revascularization decisions and PCI strategies in patients with coronary artery disease. PPG-guided adjustments in PCI planning led to improved immediate outcomes. Categories: IMAGING AND PHYSIOLOGY: Physiologic Lesion Assessment.Copyright © 2024