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      Impact of plaque characteristics on percutaneous coronary intervention-related microvascular dysfunction: insights from angiographic microvascular resistance and intravascular ultrasound

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          Abstract

          Background

          The correlation between percutaneous coronary intervention (PCI)-related microvascular dysfunction (MVD) and plaque characteristics remains unclear. To investigate this correlation and its prognosis, we assessed changes in MVD by angiographic microvascular resistance (AMR) and intracoronary ultrasound scans after PCI.

          Methods

          We conducted a retrospective study that enrolled 250 patients with coronary artery disease between July 2016 and December 2018. We collected demographic characteristics, laboratory tests, coronary angiography (CAG) and intracoronary ultrasound findings. We calculated quantitative flow ratio (QFR) and AMR by CAG. The endpoint was vessel-oriented composite outcomes (VOCOs).

          Results

          After 47 exclusions, we divided 203 cases into a deteriorated group (n=139) and an improved group (n=64) based on AMR change after PCI. Compared with the improved group, the deteriorated group had smaller lumen area [3.03 (interquartile range, 2.20–3.91) vs. 3.55 mm 2 (interquartile range, 2.45–4.57), P=0.033], higher plaque burden [78.92% (interquartile range, 73.95–82.61%) vs. 71.93% (interquartile range, 62.70–77.51%), P<0.001], and higher proportion of lipidic components (13.86%±4.67% vs. 11.78%±4.41%, P=0.024). Of 186 patients who completed 4.81±1.55 years follow-up, 56 developed VOCOs. Receiver-operating characteristic (ROC) curve analysis showed post-PCI AMR and VOCOs correlation (area under the curve: 0.729, P<0.001). Multivariate regression analysis showed post-PCI AMR >285 mmHg·s/m correlated with adverse outcome (hazard ratio =4.350; 95% confidence interval: 1.95–9.703; P<0.001).

          Conclusions

          Intravascular ultrasound (IVUS) imaging and AMR revealed an association of post-PCI MVD with a smaller lumen area, more severe plaque burden, and a higher percentage of lipidic components. Post-PCI MVD was an independent risk factor for poor prognosis.

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          Most cited references25

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          A prospective natural-history study of coronary atherosclerosis.

          Atherosclerotic plaques that lead to acute coronary syndromes often occur at sites of angiographically mild coronary-artery stenosis. Lesion-related risk factors for such events are poorly understood. In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and gray-scale and radiofrequency intravascular ultrasonographic imaging after percutaneous coronary intervention. Subsequent major adverse cardiovascular events (death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina) were adjudicated to be related to either originally treated (culprit) lesions or untreated (nonculprit) lesions. The median follow-up period was 3.4 years. The 3-year cumulative rate of major adverse cardiovascular events was 20.4%. Events were adjudicated to be related to culprit lesions in 12.9% of patients and to nonculprit lesions in 11.6%. Most nonculprit lesions responsible for follow-up events were angiographically mild at baseline (mean [±SD] diameter stenosis, 32.3±20.6%). However, on multivariate analysis, nonculprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of 70% or greater (hazard ratio, 5.03; 95% confidence interval [CI], 2.51 to 10.11; P<0.001) or a minimal luminal area of 4.0 mm(2) or less (hazard ratio, 3.21; 95% CI, 1.61 to 6.42; P=0.001) or to be classified on the basis of radiofrequency intravascular ultrasonography as thin-cap fibroatheromas (hazard ratio, 3.35; 95% CI, 1.77 to 6.36; P<0.001). In patients who presented with an acute coronary syndrome and underwent percutaneous coronary intervention, major adverse cardiovascular events occurring during follow-up were equally attributable to recurrence at the site of culprit lesions and to nonculprit lesions. Although nonculprit lesions that were responsible for unanticipated events were frequently angiographically mild, most were thin-cap fibroatheromas or were characterized by a large plaque burden, a small luminal area, or some combination of these characteristics, as determined by gray-scale and radiofrequency intravascular ultrasonography. (Funded by Abbott Vascular and Volcano; ClinicalTrials.gov number, NCT00180466.).
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            Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis.

            Quantitative flow ratio (QFR) is a novel angiography-based method for deriving fractional flow reserve (FFR) without pressure wire or induction of hyperemia. The accuracy of QFR when assessed online in the catheterization laboratory has not been adequately examined to date.
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              Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial

              Compared with visual angiographic assessment, pressure wire-based physiological measurement more accurately identifies flow-limiting lesions in patients with coronary artery disease. Nonetheless, angiography remains the most widely used method to guide percutaneous coronary intervention (PCI). In FAVOR III China, we aimed to establish whether clinical outcomes might be improved by lesion selection for PCI using the quantitative flow ratio (QFR), a novel angiography-based approach to estimate the fractional flow reserve.
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                Author and article information

                Journal
                Quant Imaging Med Surg
                Quant Imaging Med Surg
                QIMS
                Quantitative Imaging in Medicine and Surgery
                AME Publishing Company
                2223-4292
                2223-4306
                03 August 2023
                01 September 2023
                : 13
                : 9
                : 6037-6047
                Affiliations
                [1 ]deptDepartment of Cardiology, Affiliated Hangzhou First People’s Hospital , Zhejiang University School of Medicine , Hangzhou, China;
                [2 ]deptThe Fourth School of Clinical Medicine , Zhejiang Chinese Medical University , Hangzhou, China
                Author notes

                Contributions: (I) Conception and design: J Xie, J Huang, G Tong; (II) Administrative support: J Huang, G Tong; (III) Provision of study materials or patients: G Tong, J Yang, N Wang, L Zhou, X Tong; (IV) Collection and assembly of data: Y He, H Ji, S Chen, Q Hu; (V) Data analysis and interpretation: J Xie, B Gao, X Jin; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                Correspondence to: Jinyu Huang, MD; Guoxin Tong, MD. Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, No. 261 Huansha Road, Shangcheng District, Hangzhou 310006, China. Email: hjyuo@ 123456163.com ; sunnystewen@ 123456sina.com .
                [^]

                ORCID: 0000-0001-8499-7626.

                Article
                qims-13-09-6037
                10.21037/qims-23-414
                10498246
                37711841
                10b2c99c-227b-439b-a884-515be82b0b78
                2023 Quantitative Imaging in Medicine and Surgery. All rights reserved.

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                History
                : 01 April 2023
                : 10 July 2023
                Funding
                Funded by: the Funds for International Cooperation and Exchange of the National Natural Science Foundation of China
                Award ID: No. 62161160312
                Funded by: Zhejiang Provincial Key Research and Development Program
                Award ID: No. 2020C03018
                Funded by: Hangzhou Agricultural and Social Development Scientific Research Project
                Award ID: No. 20220919Y066
                Categories
                Original Article

                percutaneous coronary intervention (pci),microvascular dysfunction (mvd),plaque characteristics,coronary angiography (cag),intravascular ultrasound (ivus)

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