Post-procedural patient-reported outcomes and quality of life is worse in women than men despite similar post-PCI vFFR and vFFR-derived PPG values.

BACKGROUND

Post-procedural three-dimensional (3D) quantitative coronary angiography (QCA)-based vessel fractional flow reserve (vFFR) has shown a strong correlation with invasive FFR measurements. However, the relationship between post-percutaneous coronary intervention (PCI) vFFR, vFFR-derived pressure pullback gradient (PPG), clinical outcomes, and post-PCI quality of life (QoL) concerning sex differences remains unexplored.

METHODS

This single-centre retrospective study included patients undergoing PCI for stable or unstable angina, or non-ST-elevation myocardial infarction (NSTEMI) with two angiographic views suitable for post-PCI vFFR calculation and complete QoL assessment. Post-PCI QoL was assessed using EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire and Seattle Angina Questionnaire (SAQ). Focal disease was defined as vFFR-derived PPG ≥0.74, diffuse as values <0.74. QoL and clinical outcomes were analyzed and compared between sexes.

RESULTS

A total of 234 patients (286 vessels) were analyzed, with median follow-up of 4.21 years. The median post-PCI vFFR was 0.92 (IQR 0.90-0.95), and the median vFFR-derived PPG was 0.74 (IQR 0.65-0.84), with no significant differences between sexes. Among patients with high post-PCI vFFR (above the median of 0.92), females had lower EQ index score than males (p < 0.001). In the middle post-PCI vFFR tertile (vFFR between 0.88 and 0.93), females had lower SAQ Summary scores than males (p < 0.001). Females had significantly lower EQ Index and SAQ Summary scores compared to males among patients with both focal and diffuse disease, with all p-values <0.05. There were no differences in clinical outcomes between sexes.

CONCLUSION

This finding suggests that vFFR may be associated with post-procedural QoL, which in our study was lower in women than in men-though inconsistently across instruments or domains-despite similar post-PCI vFFR and vFFR-derived PPG values, warranting confirmation in larger, prospective studies.