Thread by @DrDamluji

Angina After Percutaneous Coronary Intervention: Patient and Procedural Predictors: @CircIntv

1 in 3 patients post FFR guided PCI had symptoms, but delta FFR (pre vs post) may be useful predictor of post PCI angina!

Here is 10 point summary 👇👇👇

1. The TARGET-FFR randomized trial found that one in three patients reported angina 3 months after undergoing percutaneous coronary intervention (PCI), which is a substantial proportion but reported previously in literature.

2. Defining a level of post-PCI angina that might be acceptable to patients or represent a clinically meaningful improvement would be arbitrary metric, as improved but persistent symptoms may be considered a success by some patients yet be completely unacceptable to others.

3. Patients reporting post-PCI angina had a higher burden of cardiovascular risk factors, including cigarette smoking, prior myocardial infarction, and atrial fibrillation at baseline.

4. Patients with post-PCI angina had more severe symptoms at baseline and were prescribed more antianginal agents, including oral and sublingual nitrates, than those who were angina-free post-procedure.

5. Patients experiencing any angina post-PCI reported effectively no improvement in quality of life as assessed by the mean change in their EQ-5D-5L weighted health index score and had significantly lower SAQ quality of life scores compared with those who were angina-free.

6. There were no significant differences between groups in angiography-based parameters of CAD severity either pre- or post-PCI. Patients with post-PCI angina had higher pre-PCI FFR and CFR values and faster hyperemic transit times.

7. Among patients who had angina at baseline, pre-PCI, absolute and percentage delta FFR values had significant correlations with patient-reported outcome measures at follow-up.

Pre-PCI FFR values drove the magnitude of this change.

8. A larger change in FFR following PCI was associated with higher QoL measures at follow-up.

Significantly lower absolute and percentage change values for FFR were observed in the post-PCI angina group. Delta FFR was found to be an independent predictor of post-PCI angina.

9. Patients with physiologically severe lesions can expect a larger improvement in intracoronary pressure ratios following PCI, which is associated with a higher likelihood of angina relief and improved quality of life.

10. Intracoronary physiology assessment can aid prediction of angina relief and quality of life improvement after stenting and help to determine the appropriateness of PCI.

In conclusion:

📊1/3 of patients in the TARGET-FFR trial reported angina 3 months after PCI, but defining a level of acceptable angina is difficult.

🩺Patients reporting post-PCI angina had a higher burden of cardiovascular risk factors and more severe baseline symptoms.

🏥Intracoronary physiology assessment can inform expectations of angina relief and quality of life improvement after stenting.