Physiology-guided percutaneous coronary intervention (PCI) is a feasible and safe approach that is associated with improved outcomes compared to standard angio-guided PCI, according to late-breaking trial data presented at EuroPCR 2022. Retrospective data from the single-center, observational, ambispective PROPHET-FFR study were presented Tuesday as late-breaking clinical research at EuroPCR 2022 in Paris – reporting that major adverse cardiovascular events (MACE) in the physiology-guided group were not statistically different from the control group and were significantly lower than the angio-guided group. Speaking at EuroPCR, Antonio Maria Leone, MD, PhD, from the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, noted that up to 30% of patients have residual ischemia or persistent symptoms after an angiographically successful PCI – adding that post-PCI physiological assessment could unveil sub-optimal results and modify outcomes. “However, real-world performance of this approach is still debatable, for sure still underused,” he said. “What is most important is that in the physiology-guided PCI, we observed a significant reduction in the MACE, especially in target vessel revascularization (TVR) in comparison to angio-guided, without a difference in myocardial infarction (MI), or cardiovascular death,” said Leone. “Interestingly, the rate of events at follow up was comparable to the control group.” Study details Leone and colleagues analyzed 1,322 patients with acute and chronic coronary syndromes undergoing an invasive surgical assessment for an angiographic intermediate coronary stenosis from January 2015 to January 2020. The team evaluated the use of full physiology-guided PCI and contemporary interventional procedures in terms of safety, visibility, in-hospital outcomes and out-of-hospital outcomes. Patients were divided into three groups according to the results of the physiological assessment and the choice of the operator. The first group (n=893) was a control group with a negative functional evaluation and deferred PCI. The second group (n= 249) contained patients with at least one ischemic lesion that was treated with conventional PCI guided by angiography. The third group (n=180) contained patients with a post-PCI assessment guided by physiology. Leone noted that the baseline characteristics of the groups were “quite well balanced,” aside from a higher number of female patients in the control group and a “slight increase” in acute coronary syndromes in an angio-guided group. In group 3, there was a non-similar FFR value at baseline for the physiology in comparison to group 2, said Leone. “As expected after PCI, there was an increase in FFR value post PCI,” he noted, noting that a suboptimal – or even ischemic – result was still seen in approximately half of the patients. “In 12% of lesions, the operator optimized the procedure with post dilatation or further stenting, with a significant increase in the final FFR value,” he said. Out-of-hospital outcomes data showed that the incidence of MACE was significantly higher in the angio-guided group (14.9%) versus control (8.2%) or the physiologically guided group (7.2%). Furthermore, TVR was also reported to be significantly reduced in the physiologically guided group versus angio-guided (5.0% vs 11.2%). No significant differences were seen in the incidence of MI or CV death. “This real-world retrospective study shows that post-PCI physiological assessment, albeit not often performed, is a feasible, safe and potentially useful approach to ameliorate PCI outcomes at follow-up,” Leone added.