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1-Year Outcomes of Blinded Physiological Assessment of Residual Ischemia After Successful PCI: DEFINE PCI Trial.

Publication ,  Journal Article
Patel, MR; Jeremias, A; Maehara, A; Matsumura, M; Zhang, Z; Schneider, J; Tang, K; Talwar, S; Marques, K; Shammas, NW; Gruberg, L; Seto, A ...
Published in: JACC Cardiovasc Interv
January 10, 2022

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).

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

January 10, 2022

Volume

15

Issue

1

Start / End Page

52 / 61

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Predictive Value of Tests
  • Percutaneous Coronary Intervention
  • Ischemia
  • Humans
  • Fractional Flow Reserve, Myocardial
  • Coronary Artery Disease
  • Coronary Angiography
  • Cardiovascular System & Hematology
  • Cardiac Catheterization
 

Citation

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Patel, M. R., Jeremias, A., Maehara, A., Matsumura, M., Zhang, Z., Schneider, J., … Stone, G. W. (2022). 1-Year Outcomes of Blinded Physiological Assessment of Residual Ischemia After Successful PCI: DEFINE PCI Trial. JACC Cardiovasc Interv, 15(1), 52–61. https://doi.org/10.1016/j.jcin.2021.09.042
Patel, Manesh R., Allen Jeremias, Akiko Maehara, Mitsuaki Matsumura, Zixuan Zhang, Joel Schneider, Kare Tang, et al. “1-Year Outcomes of Blinded Physiological Assessment of Residual Ischemia After Successful PCI: DEFINE PCI Trial.JACC Cardiovasc Interv 15, no. 1 (January 10, 2022): 52–61. https://doi.org/10.1016/j.jcin.2021.09.042.
Patel MR, Jeremias A, Maehara A, Matsumura M, Zhang Z, Schneider J, et al. 1-Year Outcomes of Blinded Physiological Assessment of Residual Ischemia After Successful PCI: DEFINE PCI Trial. JACC Cardiovasc Interv. 2022 Jan 10;15(1):52–61.
Patel, Manesh R., et al. “1-Year Outcomes of Blinded Physiological Assessment of Residual Ischemia After Successful PCI: DEFINE PCI Trial.JACC Cardiovasc Interv, vol. 15, no. 1, Jan. 2022, pp. 52–61. Pubmed, doi:10.1016/j.jcin.2021.09.042.
Patel MR, Jeremias A, Maehara A, Matsumura M, Zhang Z, Schneider J, Tang K, Talwar S, Marques K, Shammas NW, Gruberg L, Seto A, Samady H, Sharp ASP, Ali ZA, Mintz G, Davies J, Stone GW. 1-Year Outcomes of Blinded Physiological Assessment of Residual Ischemia After Successful PCI: DEFINE PCI Trial. JACC Cardiovasc Interv. 2022 Jan 10;15(1):52–61.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

January 10, 2022

Volume

15

Issue

1

Start / End Page

52 / 61

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Predictive Value of Tests
  • Percutaneous Coronary Intervention
  • Ischemia
  • Humans
  • Fractional Flow Reserve, Myocardial
  • Coronary Artery Disease
  • Coronary Angiography
  • Cardiovascular System & Hematology
  • Cardiac Catheterization