BACKGROUND Anatomical vessel location affects post-percutaneous coronary intervention (PCI) physiology. AIMS We aimed to compare the post-PCI instantaneous wave-free ratio (iFR) in left anterior descending (LAD) versus non-LAD vessels and to identify the factors associated with a suboptimal post-PCI iFR. METHODS DEFINE PCI was a multicentre, prospective, observational study in which a blinded post-PCI iFR pullback was used to assess residual ischaemia following angiographically successful PCI. RESULTS Pre- and post-PCI iFR recordings of 311 LAD and 195 non-LAD vessels were compared. Though pre-PCI iFR in the LAD vessels (median 0.82 [0.63, 0.86]) were higher compared with those in non-LAD vessels (median 0.72 [0.49, 0.84]; p<0.0001), post-PCI iFR were lower in the LAD vessels (median 0.92 [0.88, 0.94] vs 0.98 [0.95, 1.00]; p<0.0001). The prevalence of a suboptimal post-PCI iFR of <0.95 was higher in the LAD vessels (77.8% vs 22.6%; p<0.0001). While the overall frequency of residual physiological diffuse disease (31.4% vs 38.6%; p=0.26) and residual focal disease in the non-stented segment (49.6% vs 50.0%; p=0.99) were similar in both groups, residual focal disease within the stented segment was more common in LAD versus non-LAD vessels (53.7% vs 27.3%; p=0.0009). Improvement in iFR from pre- to post-PCI was associated with angina relief regardless of vessel location. CONCLUSIONS After angiographically successful PCI, post-PCI iFR is lower in the LAD compared with non-LAD vessels, resulting in a higher prevalence of suboptimal post-PCI iFR in LAD vessels. This difference is, in part, due to a greater frequency of a residual focal pressure gradient within the stented segment which may be amenable to more aggressive PCI.

中文翻译：

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基于解剖血管位置的 PCI 后生理学变化：DEFINE PCI 子研究。

背景技术血管的解剖位置影响经皮冠状动脉介入治疗（PCI）后的生理学。目的 我们的目的是比较左前降支 (LAD) 血管与非 LAD 血管的 PCI 后瞬时无波比 (iFR)，并确定与 PCI 术后次优 iFR 相关的因素。方法定义 PCI 是一项多中心、前瞻性、观察性研究，其中采用盲法 PCI 后 iFR 回撤来评估血管造影成功 PCI 后的残余缺血情况。结果 比较了 311 根 LAD 血管和 195 根非 LAD 血管的 PCI 前后 iFR 记录。虽然 LAD 血管中 PCI 前的 iFR（中位数 0.82 [0.63, 0.86]）高于非 LAD 血管（中位数 0.72 [0.49, 0.84]；p<0.0001），但 PCI 后 iFR 在非 LAD 血管中较低。 LAD 血管（中位数 0.92 [0.88, 0.94] vs 0.98 [0.95, 1.00]；p<0.0001）。LAD 血管中 PCI 后次优 iFR <0.95 的发生率较高（77.8% vs 22.6%；p<0.0001）。虽然两组中残留生理性弥漫性疾病（31.4% vs 38.6%；p=0.26）和非支架段残留病灶（49.6% vs 50.0%；p=0.99）的总体频率相似，但残留病灶的发生率相似。与非 LAD 血管相比，支架段内的异常现象在 LAD 血管中更为常见（53.7% vs 27.3%；p=0.0009）。PCI 术前至 PCI 术后 iFR 的改善与心绞痛缓解相关，无论血管位置如何。结论 血管造影成功 PCI 后，与非 LAD 血管相比，LAD 血管 PCI 后 iFR 较低，导致 LAD 血管 PCI 后次优 iFR 发生率较高。这种差异部分是由于支架段内残余焦点压力梯度的频率更高，这可能适合更积极的 PCI。