Impact of angiography derived physiological patterns of CAD and optimal hemodynamics post-PCI on residual angina

Abstract Background Focal stenotic coronary lesions, as defined by the invasive Pullback Pressure Gradient Index (PPGi) measured before percutaneous coronary intervention (PCI), are associated with less residual angina than diffuse lesions, as assessed by the Seattle Angina Questionnaire (SAQ). Purpose This study aims to investigate the interaction between a lesion’s baseline functional phenotype (focal vs. diffuse) and the physiological success of PCI, as defined by a post-procedural Murray-based angiography-derived flow ratio (μFR) above 0.90 (Adequacy of Flow, AoF), in correlation with angina status at 2 years. Methods The ASET-Japan enrolled 203 patients with chronic coronary syndrome. The baseline functional pattern of disease and the achievement of AoF (post-PCI μFR>0.90) were analysed as potential factors influencing the rate of residual angina at 2 years. Results The SAQ was obtained in 186 patients. AoF was achieved in 114 patients (61.3%), with the μFR post-PCI differing significantly by the lesion’s baseline phenotype (diffuse 0.92 vs. focal 0.94, p<0.001). At 2-year follow-up, patients in the AoF group with pre-procedural focal versus diffuse disease had significantly better angina frequency scores (99.2 vs. 94.8; p=0.007), and less frequent residual angina (6.7% vs. 22.0%, p=0.040). Conclusions The value of the baseline functional phenotype of treated lesions in predicting residual angina is overshadowed by the failure to achieve AoF. A global physiological assessment integrating AoF and the baseline functional pattern of disease is essential to accurately predict residual angina post-PCI.For image description, please refer to the figure legend and surrounding text.