Geographic disparity of pathophysiological coronary artery disease characteristics: Insights from ASET trials

• Published in: International journal of cardiology Vol. 400; p. 131805
• Main Authors: Kotoku, Nozomi, Ninomiya, Kai, Masuda, Shinichiro, Tsai, Tsung Ying, Revaiah, Pruthvi C., Garg, Scot, Kageyama, Shigetaka, Tu, Shengxian, Kozuma, Ken, Kawashima, Hideyuki, Ishibashi, Yuki, Nakazawa, Gaku, Takahashi, Kuniaki, Okamura, Takayuki, Miyazaki, Yosuke, Tateishi, Hiroki, Nakamura, Masato, Kogame, Norihiro, Asano, Taku, Nakatani, Shimpei, Morino, Yoshihiro, Ishida, Masaru, Katagiri, Yuki, De Martino, Fernando, Tinoco, João, Guimarães, Patricia O., Tanabe, Kengo, Ozaki, Yukio, Muramatsu, Takashi, Lemos, Pedro A., Onuma, Yoshinobu, Serruys, Patrick W.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2024
• Subjects: Coronary artery disease; Diffuse disease; Geographic disparity; Percutaneous coronary intervention; Pullback pressure gradient; Quantitative flow ratio; μQFR; FFR; PPG; Quantitative flow ratio; CAD; PCI; Percutaneous coronary intervention; Pullback pressure gradient; dμQFR/ds; Diffuse disease; Geographic disparity; Coronary artery disease
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2024.131805

The geographical disparity in the pathophysiological pattern of coronary artery disease (CAD) among patients undergoing percutaneous coronary intervention (PCI) is unknown. To elucidate the geographical variance in the pathophysiological characteristics of CAD. Physiological indices derived from angiography-based fractional flow reserve pullbacks from patients with chronic coronary syndrome enrolled in the ASET Japan (n = 206) and ASET Brazil (n = 201) studies, which shared the same eligibility criteria, were analysed. The pathophysiological patterns of CAD were characterised using Murray law-based quantitative flow ratio (μQFR)-derived indices acquired from pre-PCI angiograms. The diffuseness of CAD was defined by the μQFR pullback pressure gradient index. Significant functional stenoses pre-PCI (μQFR ≤0.80) were more frequent in ASET Japan compared to ASET Brazil (89.9% vs. 67.5%, p < 0.001), as were rates of a post-PCI μQFR <0.91 (22.1% vs. 12.9%, p = 0.013). In the multivariable analysis, pre-procedural μQFR and diffuse disease were independent factors for predicting a post-PCI μQFR <0.91, which contributed to the different rates of post-PCI μQFR ≥0.91 between the studies. Among vessels with a post-PCI μQFR <0.91, a consistent diffuse pattern of CAD pre- and post-PCI occurred in 78.3% and 76.7% of patients in ASET Japan and Brazil, respectively; only 6.3% (Japan) and 10.0% (Brazil) of vessels had a major residual gradient. Independent risk factors for diffuse disease were diabetes mellitus in ASET Japan, and age and male gender in Brazil. There was geographic disparity in pre-procedural angiography-based pathophysiological characteristics. The combined pre-procedural physiological assessment of vessel μQFR and diffuseness of CAD may potentially identify patients who will benefit most from PCI. •There was a geographic disparity in pre-procedural angiography-based pathophysiological characteristics.•The combined pre-procedural physiological assessment of vessel angiography-based fractional flow reserve and diffuseness of coronary artery disease (CAD) potentially identify patients who will benefit most from percutaneous coronary intervention (PCI).•Given that the physiological diffuse pattern of CAD was associated with sub-optimal results post-PCI, attention should be focused on the control of modifiable risk factors for the development and progression of diffuse disease.•The present study demonstrated that there was also a geographic disparity in the clinical risk factors associated with physiological diffuse disease.