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Post PCI Physiologic Assessment: Rationale and Current Evidence

This article discusses the rationale and current evidence for performing post stent physiology assessment after successful DES PCI, including the ability to prognosticate, understand the mechanism of residual ischemia, and potentially modify residual ischemia through additional interventions or therapies.

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Post PCI Physiologic Assessment: Rationale and Current Evidence

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  1. Post PCI Physiologic Assessment: Rationale and Current Evidence Monday, May 20, 2019 Habib Samady MD FACC FSCAI Professor of Medicine Director, Interventional Cardiology Emory University Atlanta, GA, USA

  2. Disclosures •Medtronic: PI SHEAR STENT Study •Abbott Vascular: PI Restoration Study/Institutional Research Grants • Gilead: PI MARINA Trial • Volcano Therapeutics: Research Grants Steering Comm Define PCI • American Heart Association: Mentor Fellowship Awards • National Institute of Health: Co-I NIH ROI/PPG • American College of Cardiology: Deputy Editor, JACC Interventions • Covanos Inc.: Co-Founder, CMO

  3. Why Perform Post Stent Physiology • Residual angina or ischemia despite successful DES PCI • Ability to prognosticate after successful DES PCI • Opportunity to understand mechanism of residual ischemia • Potentially modify residual ischemia by additional PCI, anti-anginals, or anti-atherosclerotic therapies

  4. Why Perform Post Stent Physiology • Residual angina or ischemia despite successful DES PCI • Ability to prognosticate after successful DES PCI • Opportunity to understand mechanism of residual ischemia • Potentially modify residual ischemia by additional PCI, anti-anginals, or anti-atherosclerotic therapies

  5. Angina often Persists despite PCI Serruys PW, et al. NEJM 2001;344:1117-24. Boden WE et al. NEJM 2007;356:1503-16. Cohen DJ et al. NEJM 2001;364:1016-26.

  6. Why Perform Post Stent Physiology • Residual angina or ischemia despite successful DES PCI • Residual angina or ischemia despite successful DES PCI • Ability to prognosticate after successful DES PCI • Opportunity to understand mechanism of residual ischemia • Potentially modify residual ischemia by additional PCI, anti-anginals, or anti-atherosclerotic therapies

  7. Studies Investigating Post Stent FFR and Outcomes Hakeem A, Uretsky B. Circulation. 2019;139:694–706

  8. FFR After BMS and MACEFFR Stent Registry Pijls et al. Circulation. 2002;105:2950- 2954

  9. Post Stent FFR and Outcomes N=574 patients (664 lesions) were followed for 31+16 months Agarwal et al. JACC Card Int. Volume 9, Issue 10, 23 May 2016, Pages 1022-1031

  10. FFR After DES and VOCEFAME and FAME II Study N=639 pts FAME and FAME II with pre and post PCI FFR Piroth et al. Circ Cardiovasc Interv. 2017;10:e005233

  11. FFR After DES and MACEDK-Crush Study N=1487 pts s/p DES PCI Li et al. JACC Cardiovascul Int. VOL. 10, NO. 10, 2017

  12. FFR After DES and MACEDK-Crush Study N=1487 pts s/p DES PCI Li et al. JACC Cardiovascul Int. VOL. 10, NO. 10, 2017

  13. Why Perform Post Stent Physiology • Residual angina or ischemia despite successful DES PCI • Ability to prognosticate after successful DES PCI • Opportunity to understand mechanism of residual ischemia • Potentially modify residual ischemia by additional PCI, anti-anginals, or anti-atherosclerotic therapies

  14. Mechanism of Impaired FFR post PCI Wolfrum et al. BMC Cardiovascular Disorders 2016;16:177

  15. Why Perform Post Stent Physiology • Residual angina or ischemia despite successful DES PCI • Ability to prognosticate after successful DES PCI • Opportunity to understand mechanism of residual ischemia • Potentially modify residual ischemia by additional PCI, anti-anginals, or anti-atherosclerotic therapies

  16. Etiology of Post Stent Pressure DropInsights from FFR Search Registry N= 100 pt with both IVUS and FFR post PCI 80 pt with Post PCI FFR<0.85 20 pt with Post PCI FFR > 0.85 Van Zaanvort et al. Circ Cardiovasc Interv. 2019 Feb;12(2):e007030.

  17. How Can PCI Optimize Post Stent FFR N=574 patients (664 lesions) were followed for 31+16 months Agarwal et al. JACC Card Int. Volume 9, Issue 10, 23 May 2016, Pages 1022-1031

  18. Proposed Algorithm for Use of Post Stent FFR Hakeem A, Uretsky B. Circulation. 2019;139:694–706

  19. How do you use FFR clinically? Questionnaire inviting 76 European FFR experts (46% response rate) Experts defined as 1st or corresponding author of at least 1 FFR publication; or 1 of the 3 largest centers using FFR in their country Tebaldi M, et al. Int J Cardiol 2016;207:206-7

  20. Why Perform Post Stent Physiology • Residual angina or ischemia despite successful DES PCI • Ability to prognosticate after successful DES PCI • Opportunity to understand mechanism of residual ischemia • Potentially modify residual ischemia by additional PCI, anti-anginals, or anti-atherosclerotic therapies

  21. Post PCI Physiologic Assessment: Rationale and Current Evidence Monday, May 20, 2019 Habib Samady MD FACC FSCAI Professor of Medicine Director, Interventional Cardiology Emory University Atlanta, GA, USA

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