Abstract

Background: The impact of intracoronary imaging guidance on final coronary flow in older patients with coronary artery disease (CAD) and undergoing  percutaneous coronary intervention (PCI) remains unclear.

Methods: Older patients with chest pain and undergoing diagnostic coronary angiography (CAG) were selected. Those with significant CAD on diagnostic  CAGwere proceeded with CAG or intravascular ultrasound (IVUS)-guided PCI, and pre- and post-procedural coronary flow was assessed using  angiography-derived quantitative flow ratio (QFR).

Results: The analysis included 37 participants (15 healthy controls and 22 patients with significant CAD; mean age 72 ± 8 and 70% male). The CAG-guided  PCI was performed for 10 culprit lesions in 9 patients, while IVUS-guided PCI was performed for 14 culprit lesions in 13 patients. Pre-procedural culprit vessel QFR was comparable between lesions in CAG and IVUS-guided PCI groups (0.50 ± 0.17 vs. 0.49 ± 0.31, p = 0.920). Post-procedural culprit vessel QFR, however, was significantly lower in the CAG-guided PCI group compared to the IVUS group (0.89 ± 0.06 vs. 0.95 ± 0.02, p = 0.003). Additionally, post-procedural QFR improvement in the left anterior descending (LAD) and left circumflex (LCx) was similar to healthy controls in the IVUS-guided PCI group  (0.89 ± 0.15 vs. 0.91 ± 0.06, p = 0.667 for LAD and 0.94 ± 0.06 vs. 0.96 ± 0.03, p = 0.221 for LCx) but significantly lower in the CAG-guided PCI group (0.81  ± 0.13 vs. 0.91 ± 0.06, p = 0.009 for LAD and 0.90 ± 0.11 vs. 0.96 ± 0.03, p = 0.041 for LCx).

Conclusion: In older patients with stable CAD, IVUS-guided PCI provides better post-procedural QFR compared to CAG-guided PCI, with QFR values similar to healthy individuals.